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An extremely rare variety of anomalous coronary artery: right coronary artery originating from the distal left circumflex artery.

Chung SK, Lee SJ, Park SH, Lee SW, Shin WY, Jin DK - Korean Circ J (2010)

Bottom Line: The right coronary artery did not originate from the aorta, but instead emerged from the distal left circumflex artery, with significant stenosis at the proximal portion of the left anterior descending artery.A stent was successfully implanted at the culprit lesion.There was no perfusion defect detected by a cardiac SPECT study.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.

ABSTRACT
A single coronary artery (SCA) is a rare congenital anomaly of the coronary circulation, which is often associated with myocardial ischemia and other congenital cardiac anomalies. A 77-year-old woman visited our hospital complaining of typical chest pain. Coronary angiography revealed an isolated SCA. The right coronary artery did not originate from the aorta, but instead emerged from the distal left circumflex artery, with significant stenosis at the proximal portion of the left anterior descending artery. A stent was successfully implanted at the culprit lesion. There was no perfusion defect detected by a cardiac SPECT study.

No MeSH data available.


Related in: MedlinePlus

Coronary angiography. An aberrant branch, extending from the distal left circumflex artery, continued to the right atrioventricular groove, covering the territory of the right coronary artery (A). Aortography showed the absence of the right coronary ostium (B).
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Figure 2: Coronary angiography. An aberrant branch, extending from the distal left circumflex artery, continued to the right atrioventricular groove, covering the territory of the right coronary artery (A). Aortography showed the absence of the right coronary ostium (B).

Mentions: A 77-year-old woman presented with complains of progressive effort-related chest pain for 20 days. She had no particular medical history. On physical examination, the blood pressure was 130/70 mmHg, and her pulse rate was 76 beats/min. Her heart sounds were normal and no murmur was heard. The electrocardiogram displayed normal sinus rhythm without any ST depression or T-wave inversion. The transthoracic echocardiography demonstrated normal hemodynamics with a normal pattern of contractility. The coronary angiography showed that the left coronary artery originated normally from the left sinus of Valsalva, but revealed a 90% tight stenosis at the proximal portion of the left anterior descending artery (Fig. 1). The figure of the left circumflex artery was unique, in that an aberrant branch extended from the distal left circumflex artery, which crossed the crux and continued to the right atrioventricular groove, covering the territory of the right coronary artery (Fig. 2A). After several failed attempts to engage the right coronary artery, we performed aortography using a power injector to exclude high take-off of the right coronary artery. This also confirmed the absence of the right coronary ostium (Fig. 2B). Without delay, we successfully deployed a 4.0×12 mm zotarolimus-eluting stent (Endeavor™, Medtronic Vascular, Santa Rosa, CA, USA) at the left anterior descending artery, after intravenous injection of 5,000 IU heparin. Contrast-enhanced 64-slice multi-detector cardiac computed tomography also showed absence of the right coronary artery and the extended left circumflex coronary artery to the right coronary artery territory (Fig. 3). Before discharge, a technetium-99m single photon emission computerized tomography (SPECT) study demonstrated noregional any regional perfusion defect. The stent was intact in an 8-month follow-up coronary angiography.


An extremely rare variety of anomalous coronary artery: right coronary artery originating from the distal left circumflex artery.

Chung SK, Lee SJ, Park SH, Lee SW, Shin WY, Jin DK - Korean Circ J (2010)

Coronary angiography. An aberrant branch, extending from the distal left circumflex artery, continued to the right atrioventricular groove, covering the territory of the right coronary artery (A). Aortography showed the absence of the right coronary ostium (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957636&req=5

Figure 2: Coronary angiography. An aberrant branch, extending from the distal left circumflex artery, continued to the right atrioventricular groove, covering the territory of the right coronary artery (A). Aortography showed the absence of the right coronary ostium (B).
Mentions: A 77-year-old woman presented with complains of progressive effort-related chest pain for 20 days. She had no particular medical history. On physical examination, the blood pressure was 130/70 mmHg, and her pulse rate was 76 beats/min. Her heart sounds were normal and no murmur was heard. The electrocardiogram displayed normal sinus rhythm without any ST depression or T-wave inversion. The transthoracic echocardiography demonstrated normal hemodynamics with a normal pattern of contractility. The coronary angiography showed that the left coronary artery originated normally from the left sinus of Valsalva, but revealed a 90% tight stenosis at the proximal portion of the left anterior descending artery (Fig. 1). The figure of the left circumflex artery was unique, in that an aberrant branch extended from the distal left circumflex artery, which crossed the crux and continued to the right atrioventricular groove, covering the territory of the right coronary artery (Fig. 2A). After several failed attempts to engage the right coronary artery, we performed aortography using a power injector to exclude high take-off of the right coronary artery. This also confirmed the absence of the right coronary ostium (Fig. 2B). Without delay, we successfully deployed a 4.0×12 mm zotarolimus-eluting stent (Endeavor™, Medtronic Vascular, Santa Rosa, CA, USA) at the left anterior descending artery, after intravenous injection of 5,000 IU heparin. Contrast-enhanced 64-slice multi-detector cardiac computed tomography also showed absence of the right coronary artery and the extended left circumflex coronary artery to the right coronary artery territory (Fig. 3). Before discharge, a technetium-99m single photon emission computerized tomography (SPECT) study demonstrated noregional any regional perfusion defect. The stent was intact in an 8-month follow-up coronary angiography.

Bottom Line: The right coronary artery did not originate from the aorta, but instead emerged from the distal left circumflex artery, with significant stenosis at the proximal portion of the left anterior descending artery.A stent was successfully implanted at the culprit lesion.There was no perfusion defect detected by a cardiac SPECT study.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.

ABSTRACT
A single coronary artery (SCA) is a rare congenital anomaly of the coronary circulation, which is often associated with myocardial ischemia and other congenital cardiac anomalies. A 77-year-old woman visited our hospital complaining of typical chest pain. Coronary angiography revealed an isolated SCA. The right coronary artery did not originate from the aorta, but instead emerged from the distal left circumflex artery, with significant stenosis at the proximal portion of the left anterior descending artery. A stent was successfully implanted at the culprit lesion. There was no perfusion defect detected by a cardiac SPECT study.

No MeSH data available.


Related in: MedlinePlus