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Case Studies | Cardiology Science | India | Volume 12 Issue 4, April 2023
A Rare Variant of Single Coronary Artery: Anomalous Origin of Right Coronary Artery Arising from Left Anterior Descending Artery
Dr. B. Adilakshmi | Dr. Ashish Devalkar .T  | Dr. B. Naga Malli Kumar
Abstract: Background: Coronary artery anomalies are identified in 0.6% to 1.55% of patients who undergo coronary angiography. Single coronary artery (SCA) is a rare coronary artery anomaly with a reported incidence between 0.024% and 0.098%. Although majority of patients with coronary artery anomalies are asymptomatic, some may present with ischemia, heart failure and sudden cardiac death, especially when they are associated with malignant course. Here we report an interesting rare case of a single coronary artery from the left coronary sinus with anomalous origin of the right coronary artery from the mid - segment of the left anterior descending coronary artery. Case Summary: A 59 - year - old diabetic, hypertensive, post - menopausal woman presented with exertional dyspnea of 1 week duration. ECG showed Sinus rhythm with LBBB pattern.2D echo was suggestive of dilated left ventricle with global hypokinesia and severe Left ventricular dysfunction. Coronary angiography was done after stabilisation which showed single coronary artery (LMCA) arising from left sinus of Valsalva dividing into Left anterior descending artery (LAD), non - dominant left circumflex artery (LCx) and Ramus. An anomalous Right coronary artery (RCA) was seen originating from mid portion of Left anterior descending artery (LAD) just after second diagonal and it courses anteriorly down the right atrioventricular groove. CT Coronary angiography showed Left Main coronary artery (LMCA) with normal origin was seen dividing into Left anterior descending artery (LAD), left circumflex artery (LCx) and Ramus. Left anterior descending artery (LAD), Ramus and left circumflex artery (LCx) were normal with no luminal stenosis or non - calcified lesions in any segment. Right coronary artery was seen arising from Left anterior descending artery (LAD) crossing to the right side anterior to right ventricular outflow tract and extending into atrioventricular groove and its vascular lumen and walls were normal. Patient was treated medically and was discharged in stable condition. Conclusion: Coronary artery anomalies (CAA) are a very rare form of congenital cardiac anomaly. Furthermore, the anomalous origin of the RCA from the LAD artery is a rare form of single coronary artery in which the anomalous RCA arises from the proximal or mid - portion of the LAD. This anomaly often has a benign course except when RCA traveling between the pulmonary artery and aorta involves surgical management.
Keywords: Coronary artery anomalies, CAA, Single coronary artery, SCA, Right coronary artery, RCA, CT coronary Angiography, CTCA
Edition: Volume 12 Issue 4, April 2023,
Pages: 1392 - 1395