Abstract
BackgroundAnomalous coronary arteries occur in less than 1% of the population and have been implicated in sudden cardiac and exercise-related death. The most common variant involves the left circumflex artery arising from a separate ostium than the left coronary artery. This case demonstrates a rare variation in which all three coronary arteries arise from a shared, single, ostium originating from the right coronary cusp.Case presentationWe report the case of a 63-year-old Caucasian man with a history of myocardial infarction, congestive heart failure, and atrial fibrillation who presented for syncope. Inpatient ischemic workup, including coronary angiography, demonstrated a rare coronary anomaly which included all three coronary arteries arising from a shared, single, ostium originating from the right coronary cusp. Our patient was treated conservatively with an option for coronary bypass if symptomatic.ConclusionSurgical management is indicated in high-risk patients, but the optimal management for a nonmalignant, shared origin for all three coronary arteries has not been explored in detail.
Highlights
Coronary artery anomalies (CAA) are caused by developmental malformations, typically congenital, within the coronary arteries. These abnormalities are benign and related to origin and/or location of these arteries and it is estimated that less than 1% of the population possess CAA, the most common variant being a separate origin of the left anterior descending (LAD) and left circumflex artery (LCX) occurring in approximately 0.4% of cases, followed by the LCX arising from the right coronary artery (RCA) in approximately 0.37% of cases [1]
Case presentation Our patient is a 63-year-old Caucasian man with a past medical history of recent myocardial infarction (MI) status post unsuccessful percutaneous coronary intervention, heart failure with reduced ejection fraction (25– 30%), coronary artery disease, and atrial fibrillation who presented to our institution with a 3-day history of syncope without chest pain or dyspnea
Less than 1% of the general population is estimated to have CAA, the majority of which involve different ostia of the LCX and when the LAD and LCX artery arise from the right coronary ostium [1]
Summary
Patients with CAA should undergo further investigations to delineate the origin and course of the arteries involved; CCTA is usually helpful in such cases. A nonmalignant, single, shared origin of all three coronary vessels is a very rare entity. There are no official guidelines addressing the optimal management approach. 4. Reul RM, Cooley DA, Hallman GL, Reul GJ. Surgical treatment of coronary artery anomalies: report of a 37 1/2-year experience at the Texas Heart Institute. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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