Anomalous Origin of Right Coronary Artery from the Left Anterior Descending Artery

Abstract

Anomalous origin of right coronary artery from the left anterior descending artery is an extremely rare coronary anomaly. We report the case of a 57-year-old patient presented with effort angina. Coronary angiography revealed that an anomalous RCA originated from the middle LAD. The anomalous RCA had also critical ostial stenosis and LAD had some meaningless lesions in the proximal and mid segments. Computed tomographic angiography confirmed anomalous RCA originating from the middle portion of LAD and coursing anterior of the pulmonary artery to the right atrioventricular groove. We proposed medical management for this patient. The anomalous origin of the RCA as a branch of the LAD artery is a very rare variation of single coronary artery. It is usually asymptomatic and fortuitous discovery but can be associated with a risk of myocardial ischemia and sudden cardiac death especially if the anomalous artery had an inter-arterial course. Computed tomographic angiography is an important non-invasive diagnostic tool for establishing the course of the vessel and may be adjunct to angiography. Treatment of coronary anomalies is still controversial; it may be medical, surgical or percutaneous.