Single coronary artery with anomalous origin of the right coronary artery as a branch from the left anterior descending artery: a very rare coronary anomaly

Anomalous right coronary artery: case series and review of literature

Anomalous right coronary arteries (ARCA) are extremely rare in general population. Although mostly asymptomatic and recognized incidentally on cardiac catheterizations, they can be catastrophic and can cause sudden cardiac death. Sudden cardiac deaths are more common when the anomalous vessel runs an inter-arterial course between the aorta and the pulmonary artery. Asymptomatic patients with malignant course of anomalous coronaries can pose clinical dilemmas. Based on prior experience, management of asymptomatic ARCA with malignant course should be subjected to a risk-benefit analysis. This case series begins with a brief description of four separate cases of ARCA. They had their origin in the left coronary sinus or off left anterior descending artery (LAD). Three of them had anterior course between aorta and pulmonary trunk, confirmed by coronary CT angiography (CTA). Whereas two of our patients presented with chronic symptoms, two presented as acute cases with electrocardiographically proven STEMI. These cases were managed differently; by conservative, surgical or interventional approaches. All four cases had good final outcomes. This goes to show how different treatment options can be employed in management of complications associated with anomalous coronary arteries. It is also interesting to note that the radial access provides better guide support that is needed to tackle complex lesions. Many operators have been using radial approach for anomalous coronary interventions. We have successfully employed radial technique after failed trans-femoral attempts and also in STEMI situations. Based on our experience, right radial approach appears to be safer and quicker.

A patient with anomalous right coronary artery originating from the left anterior descending artery who underwent complex percutaneous coronary intervention: A case report

An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. A 71-year-old patient presented with severe exertional angina for 10 days. Coronary angiography revealed that an anomalous RCA originated from the proximal LAD. The anomalous RCA had also critical ostial stenosis and the LAD had a critical lesion before origin of RCA (95%) and chronic total occlusion (CTO) at DII branch level. Furthermore, extremely tortuous circumflex (Cx) artery had critical tandem lesions at the mid portion. Surgical treatment was offered, but the patient refused the surgery. We decided to perform percutaneous coronary intervention (PCI). The first stage of PCI was on Cx artery. Two floppy guide wires were placed into the Cx artery and a long drug-eluting stent (DES) could be placed. Secondly, the LAD CTO lesion could be crossed by Confianza pro 9 wire. After the predilatation, another DES was placed into the LAD CTO region. Then all other significant lesions were successfully treated with PCI in a single session. <Learning objective: An anomalous right coronary artery (RCA) arising from the left anterior descending artery (LAD) is an extremely rare coronary anomaly. This is the first report of case of a patient with an anomalous RCA originating from the proximal LAD and complex coronary atherosclerosis, who underwent successful complex percutaneous coronary intervention (PCI) in a single session. PCI may be an alternative treatment choice to surgery, especially in patients with high surgical risk and complex coronary anatomy.>.

The mystery of the lost and found right coronary artery

Most coronary artery anomalies are discovered only incidentally during coronary angiography. Recognition and identification of these anomalies especially during coronary intervention procedures are of importance because of their occasional association with symptoms due to atherosclerotic coronary disease. Anomalous origin of the right coronary artery (RCA) from the left anterior descending coronary artery (LAD) is one of the most uncommon coronary anomalies. We report an extremely interesting case of anomalous RCA from the LAD presenting as acute inferior ST elevation MI, with ostial total block of the RCA, precluding its visualization during coronary angiography. Interventional Cardiologists need to be aware of such anatomical variations, as occasionally, this can lead to a diagnostic dilemma, as in our case.

Right coronary artery originating from left anterior descending artery: a case report

Right Coronary Artery (RCA) originating from left anterior descending artery is a very rare congenital coronary artery anomaly. A 66-year-old man presented with hypertension and complaints of exertional chest pain. The angiography was performed. Aortic root angiography showed no coronary ostium originating from the right sinus of valsalva. Right coronary artery was visualized as anomalously originating from the midportion of left anterior descending artery. Severe stenosis were seen in ostium of anomalous right coronary artery, in midportion of left anterior descending and in midportion of circumflex artery. The patient was referred for coronary artery bypass grafting. The patient underwent coronary artery bypass surgery for three vessels. He was discharged home on postoperative day 7 without any complication. His echocardiogram on follow-up visit revealed good biventricular function.

Single coronary artery: right coronary artery originated from middle of left anterior descending artery in a patient with severe mitral regurgitation

The single coronary artery is a benign and very rare coronary artery abnormality. Anomalous origin of the right coronary artery originating from the left anterior descending artery has been reported previously in just a few cases. In this article, we presented a patient with an anomalous origin of the right coronary artery from the midportion of the left anterior descending artery. The anomalous coronary artery was discovered incidentally during a coronary angiography performed prior to mitral valve surgery.

Anomalous right coronary artery originating from the left anterior descending artery: case report and review of the literature

The anomalous origin of the right coronary artery (RCA) as a branch of the left anterior descending (LAD) artery is a very rare variation of single coronary artery. At least 36 cases have been described previously in the literature. The vast majority of previous reports have described a single anomalous vessel with its origin after the first septal perforator of the LAD, which courses anterior to the right ventricular outflow tract to reach territory normally served by the right coronary artery. Of 35 cases in structurally normal hearts, 19 (54%) patients had >50% narrowing in one or more epicardial coronary arteries (54%), at least 14 (40%) of whom required revascularization. Thirteen cases (37%) did not have significant coronary artery disease, while the remaining 3 cases were unclear. The current report reviews previous reports of this anomaly and describes a patient with an anomalous RCA from the mid-LAD, in whom heart block, back pain and dyspnea was the initial manifestation of ischemia. On heart catheterization, there was significant coronary artery disease in the LAD proximal to the origin of the anomalous artery. The patient was successfully revascularized with a unique sequential left internal mammary artery bypass to the anomalous vessel and LAD.

Anomalous origin of the right coronary artery from the left anterior descending artery in a patient with single left coronary artery: A rare coronary artery anomaly and review of the literature

A 44-year-old woman with hypertension was admitted because of recent onset chest pain. Coronary angiography revealed an anomalous right coronary artery originating as a separate branch from the left anterior descending artery. Associated with the present case all published case reports were thoroughly investigated and presented as a review of the literature.

Hyperdominant left anterior descending artery continuing across left ventricular apex as posterior descending artery coexistent with aortic stenosis

We describe, in a 61 year old man, with coexistent aortic stenosis, the anomalous origin of posterior descending artery (PDA) from a stenotic left anterior descending (LAD) artery, as its continuation across the left ventricular apex, in the presence of a normally arising and atretic proximal right coronary artery. The patient underwent mechanical aortic valve replacement and triple coronary artery bypass grafting and made an uneventful recovery. To the best of our knowledge, origin of PDA as a continuation of LAD across the left ventricular apex in the presence of a normally arising but atretic proximal right coronary artery has never been described in literature before. There is one previous case report of continuation of LAD as PDA across the left ventricular apex in a patient with single left coronary coronary artery with an absent right coronary ostium. As the blood supply to the entire interventricular septum is derived from this "hyperdominant" LAD system, stenosis of LAD can be catastrophic. A review of literature of the anomalies of right coronary artery and, in particular, of its anomalous origin from LAD and its coexistence with aortic stenosis, is presented.

Right coronary artery arising as a terminal extension of the circumflex artery (a rare coronary artery anomaly)

A single coronary artery is a very rare type of coronary artery anomaly that may present in various forms. A patient is presented in whom the right coronary artery coursed as the terminal branch of the left circumflex artery. This is the second case of this anomaly in the literature.

Single left coronary artery with separate origins of proximal and distal right coronary arteries from left anterior descending and circumflex arteries--a previously undescribed coronary circulation

A single left coronary artery with right coronary artery arising from either left main stem (LMS) or left anterior descending artery (LAD) or circumflex artery (Cx) is an extremely rare coronary anomaly. This is the first report of separate origins of proximal and distal RCA from LAD and circumflex arteries respectively in a patient with a single left coronary artery. This 57 year old patient presented with unstable angina and severe stenotic disease of LAD and Cx arteries and underwent urgent successful quadruple coronary artery bypass grafting. The anomalies of right coronary artery in terms of their origin, number and distribution are reviewed.

Single Coronary Artery With Anomalous Origin of the Right Coronary Artery From the Left Anterior Descending Artery With a Unique Proximal Course

A 62-year-old man with hypertension and hypercholesterolemia was referred to our unit for evaluation of chest pain. A very rare variant of single coronary artery, in which the anomalous right coronary artery originated as a separate branch from the left anterior descending artery, was incidentally found on his coronary angiography. The anomalous right coronary artery in our case appears to be unique in that it courses intraseptally rather than rightwards proximally and has obstructive atherosclerotic lesions resulting in inferior ischemia. Moreover, the acute angle made by the anomalous right coronary artery to turn toward the atrioventricular groove may have reduced the flow velocity and contributed to the development of inferior ischemia.