Anomalous origin of the right coronary artery from the left anterior descending coronary artery

Diagnosis and percutaneous coronary intervention of an anomalous right coronary artery originating from the middle of the left anterior descending artery: a case report

A single left coronary artery is a very rare anomaly in which only the left coronary artery arises from the aortic trunk by a single coronary ostium and supplies the entire heart. The present report is one of the few describing a patient with an anomalous right coronary artery originating from the middle of the left anterior descending artery. The patient presented with acute myocardial infarction with the culprit lesion on the left circumflex artery. Multivessel angioplasty was successfully performed in a two-step approach: the first for the culprit lesion and the second on the anomalous coronary artery. Decisions about treatment modalities for an anomalous coronary artery should be made only after considering the patient’s clinical characteristics and performing additional imaging diagnostics with a clearly defined coronary anatomy.

Unusual trifurcation of a single left coronary artery

Congenital coronary artery anomalies are rare and usually an incidental finding during coronary angiography. Most of the anomalies are benign in nature; however, some are malignant and may result in sudden cardiac death. A 46-year-old woman with diabetes and hypertension underwent coronary angiography for evaluation of exertional angina, which revealed an unusual trifurcation of a single left coronary artery with an anomalous origin of the right coronary artery from the left anterior descending artery but no significant coronary narrowing. The patient was managed conservatively.

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 right coronary artery from the mid-left anterior descending artery

We report a case of a right coronary artery (RCA) originating from the mid-left anterior descending artery (LAD) coursing around and in front of the pulmonary artery. The anomaly was discovered incidentally during cardiac catheterization. It is only the second case of such an anomaly ever described.

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.