Anomalous origin of the left anterior descending artery from the right coronary artery: A case report
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Keywords
Coronary Vessel Anomalies, Coronary Angiography, Tomography, X-Ray Computed; , Myocardial Ischemia, Left Anterior Descending Artery
Abstract
Background: Congenital coronary anomalies represent a heterogeneous spectrum of anatomical variants that may predispose to myocardial ischemia, arrhythmias, and sudden cardiac death, particularly when the vessel follows an interarterial course. Although their prevalence is low, timely recognition is essential to prevent unnecessary interventions and guide appropriate treatment. The objective was to describe a case of anomalous origin of the left anterior descending (LAD) artery from the right coronary artery, highlighting the role of multimodality imaging in anatomical characterization and therapeutic decision-making.
Case report: A 66-year-old woman with hypertension, type 2 diabetes, and dyslipidemia presented with severe oppressive chest pain in the context of a non-ST-segment elevation myocardial infarction. Initial coronary angiography suggested chronic LAD occlusion with heterocoronary circulation from the right coronary artery. An attempted percutaneous coronary intervention was unsuccessful. Reevaluation with coronary CT angiography revealed an anomalous LAD origin from the right coronary artery, in addition to a hypoplastic native LAD arising from the left main coronary trunk, findings that explained the initial diagnostic discordance.
Conclusions: Early recognition of rare coronary variants through multimodality imaging allows for tailored diagnostic and therapeutic strategies, since it prevents unnecessary procedures, enhances patient safety, and supports individualized management based on vessel course and hemodynamic significance.
References
1. Narula J, Chandrashekhar Y, Ahmadi A, et al. SCCT 2021 expert consensus document on coronary computed tomographic angiography. J Cardiovasc Comput Tomogr. 2021;15(3):192-217. doi: 10.1016/j.jcct.2020.11.001
2. Gentile F, Castiglione V, De Caterina R, et al. Coronary artery anomalies. Circulation. 2021;144(12):983-96. doi: 10.1161/CIRCULATIONAHA.121.055347
3. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC chest pain guideline. Circulation. 2021;144(22):e368-454. doi: 10.1161/CIR.0000000000001029
4. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. doi: 10.1093/eurheartj/ehaa554
5. El-Am EA, Ferreira AL, Kerkar P, et al. Anomalous LAD arising from the RCA with myocardial bridging. Front Cardiovasc Med. 2020;7:57. doi: 10.3389/fcvm.2020.00057
6. Rajani P, Chue CD, Kharbanda RK, et al. Anomalous left coronary artery arising from the right coronary sinus. JACC Asia. 2021;1(1-2):142-4. doi: 10.1016/j.jaccas.2021.04.003
7. Karikalan S, Pajanivel R, Thenmozhi P, et al. Anomalous origin of LAD from right coronary ostium. Cureus. 2021;13(10):e18986. doi: 10.7759/cureus.18986
8. Jang SW, Lee EJ, Kim SM, et al. Type 4 dual left anterior descending artery. Korean J Radiol. 2024;25(7):558-62. doi: 10.3348/kjr.2023.0991
9. Kassem J, Marji M, Nasr S, et al. Dual left anterior descending artery: a case report. Eur Heart J Case Rep. 2024;8(7):ytae272.
10. Ojha V, Seth T, Sharma S, et al. Unique variant of dual left anterior descending artery. BMJ Case Rep. 2020;13(10):e234275. doi: 10.1136/bcr-2020-234275
11. Han P, Liu Y, Chen J, et al. Anatomical characteristics of anomalous left coronary from opposite sinus. Int J Cardiol Heart Vasc. 2020;29:100550. doi: 10.1016/j.ijcha.2020.100550
12. Bigler MR, Buser PT, Corti R, et al. Therapeutic management of anomalous coronary arteries from the opposite sinus. J Am Heart Assoc. 2022;11(11):e027098. doi: 10.1161/JAHA.122.027098
13. Tang CX, Han Y, Schoepf UJ, et al. CCTA-derived evaluation of anomalous coronary arteries. Korean J Radiol. 2020;21(3):274-88. doi: 10.3348/kjr.2019.0230
14. Zhang C, Shi D. Left anomalous coronary artery originating from the opposite sinus causing acute myocardial infarction. Medicine (Baltimore). 2024;103(39):e39850. doi: 10.1097/MD.0000000000039850
15. Sen G, Sousa S, Cunnington C, et al. Anomalous origin of LAD from right sinus: CTCA. Clin Case Rep. 2020;8(2):303-6. doi: 10.1002/ccr3.2642
16. Dheeraj AB, Bahubali VB, Radhakrishnan N, et al. Dual LAD with intramyocardial course. Autops Case Rep. 2020;10(4):e2020223. doi: 10.4322/acr.2020.223
17. Albuquerque FN, Kajimoto K, Hegde VA, et al. Anomalous origin of the right coronary artery with interarterial course: mid-term follow-up. Sci Rep. 2021;11:18315. doi: 10.1038/s41598-021-97917-w
18. Gaudino M, Anselmi A, D’Ascenzo F, et al. Management of adults with AAOCA. J Am Coll Cardiol. 2023;82(15):1440-62. doi: 10.1016/j.jacc.2023.08.012
19. Agarwal PP, Dennie C, Pena E, et al. Dual LAD: CT findings. AJR Am J Roentgenol. 2008;191(6):1698-701. doi: 10.2214/AJR.08.1193
20. Bigler MR, Corti R, Seiler C, et al. Hemodynamic relevance of anomalous coronary arteries. Front Cardiovasc Med. 2021;8:591326. doi: 10.3389/fcvm.2020.591326
21. Patel N, Khan N, Shetty R, et al. Anomalous LAD origin diagnosed incidentally in NSTEMI. Cureus. 2021;13(10):e74057. doi: 10.7759/cureus.74057
22. Rajani P, Rigby AS, Thompson J, et al. Anomalous left coronary artery from right cusp with anterior STEMI: case report. JACC Case Rep. 2021;3(2):293-6. doi: 10.1016/j.jaccas.2021.04.003
23. Kumar PA, Patel B, Dasari M, et al. Anomalous aortic origin of the right coronary artery from left cusp: a management conundrum. J Med Case Rep. 2023;17:191. doi: 10.1186/s13256-023-03921-1
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