Origin, Course, and Angulation of Coronary Artery Anomaly - A Case Report

Congenital coronary artery anomalies are a rare diagnosis that can be silent when the patient is asymptomatic. Although these abnormalities may, in most cases, not present clinical alterations, in some cases, they prove to be a cause of myocardial ischemia and sudden death. We report the case of a 20-year-old asymptomatic patient, seen in a routine cardiology consultation, evidenced in an ergometric test ST-segment depression. In this case, follow-up was carried out with coronary angiotomography and scintigraphy to understand the reason for this finding. After the angiotomography has evidenced the diagnosis of anomalous origin and course of the right coronary artery and the trunk of the left coronary artery, in addition to anomalous angulation of the right coronary vessel.

Anomalous Left Coronary Artery Originating from the Right Coronary Sinus with an Interarterial Course: a Case Report and Literature Review

Introduction: The diagnosis of coronary artery anomalies (CAAs) can be challenging due to the highly variable manifestations and symptoms. CAAs occur in less than 1% of the population. Multidetector cardiac computed tomography angiography (CTA) provides excellent spatial and temporal resolution for the imaging of CAAs. This case report describes an anomalous origin of the left main coronary artery.

Case presentation: A 64-year-old woman with atypical chest pain underwent coronary CTA. The CT demonstrated that the left coronary artery was originating from the right coronary sinus and had an interarterial course with an approximately 50% stenosis at the segment between the great arteries. Invasive coronary angiography confirmed hemodynamically significant stenosis of the interarterial segment. The patient underwent off-pump coronary artery bypass graft surgery.

Conclusion: Left coronary artery originating from the right coronary sinus with an interarterial course increases the risk of sudden cardiac death. In these patients, surgical revascularization is recommended. However, timely diagnosis, especially in those with mild symptoms, remains challenging. Coronary CTA is a robust tool to diagnose CAA and provides valuable information to support the clinical decision making in this patient population.