Ostial atresia of left circumflex coronary artery arising from non-coronary sinus: a combination of rare anomalies
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CASE REPORT
Ostial atresia of left circumflex coronary artery arising from non-coronary sinus: a combination of rare anomalies M. P. Girish1 • Mohit D. Gupta1 • Vivek Chaturvedi1 • Amit Gupta1 Sonali Sethi1
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Received: 4 June 2015 / Accepted: 11 August 2015 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract Atresia of the left coronary artery ostium and right coronary artery ostium is a rare anatomic variant of the coronary circulation. Atresia of the left circumflex artery and its origin of from the non-coronary sinus have never been described. We report this unusual combination of rare anomalies for the first time. Keywords Coronary artery anomaly Atresia Anomalous origin
Introduction Coronary artery anomalies have been identified in 0.6–1.5 % of coronary angiograms [1]. Among the coronary artery anomalies, the least frequently observed is coronary artery ostial atresia. Atresia of the left coronary artery ostium and right coronary artery ostium is a rare anatomic variant of the coronary circulation [2]. We report congenital ostial atresia of anomalous left circumflex (LCx) artery from non-coronary sinus. The LCx was opacified by inter-coronary communication from the posterior left ventricular branch of the right coronary artery proceeding to the unusual sinus. Such a course has never been reported in the literature. Electronic supplementary material The online version of this article (doi:10.1007/s12928-015-0350-4) contains supplementary material, which is available to authorized users. & Mohit D. Gupta [email protected] 1
Department of Cardiology and Radiology, GB Pant Hospital and Associated Maulana Azad Medical College, Room 125, Academic Block, First Floor Dept of Cardiology, New Delhi 110002, India
Case A 48-year-old male patient who is a non-diabetic and a chronic smoker, presented with acute coronary syndrome with episodes of rest angina for the last 20 days. There was no history of any angina prior to this episode. Clinical examination did not reveal any significant abnormality. Electrocardiogram showed new-onset T wave inversion in leads V4–6 at the time of presentation to the emergency room. Two-dimensional echocardiography showed normal global left ventricular ejection fraction with no regional wall motion abnormality. Qualitative Troponin T test was positive. He was taken up for coronary angiography. Selective angiogram of the left coronary artery revealed a moderately diseased diagonal artery, normal LAD and significantly stenosed ramus intermedius (Fig. 1a). Acute coronary syndrome was due to the ramus intermedius. Percutaneous intervention of the ramus intermedius was carried out with one drug eluting stent (Fig. 2a, b). The left circumflex artery was not visualized. An angiogram of the right system showed normal RCA (in course and caliber). Surprisingly, postero-lateral ventricular (PLV) artery continued in left AV groove (at the site of Lcx) as a normal caliber left circumflex artery (Fig. 1b). However, the anomalous LCx did not follow its normal
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