Abstract
Coronary artery anomalies are clinically important as there have been reports of sudden death, fatal and non-fatal myocardial infarction associated with exercise in persons with certain types of unusual coronary anatomy. Anomalous origin of the circumflex artery is not an uncommon finding; however dual origin of the circumflex artery is a rare anomaly. An extensive search of literature indicates that there have been only two such prior reports, both with nondominant anomalous left circumflex arteries. We describe here the first report of 'twin' circumflex arteries with the anomalous dominant circumflex coronary artery arising from the right coronary trunk and a non-dominant circumflex artery from left coronary artery. This was diagnosed by conventional coronary angiography and then confirmed with 64-slice multidetector computed axial tomographic (MDCT) angiography. To the best of our knowledge, this is the first report of twin circumflex coronary artery clearly demonstrated by both invasive and non-invasive techniques. No such confirmation by MDCT angiography has previously been reported in literature.
Highlights
Anomalies of the coronary arteries have been found in 1-2% of patients undergoing coronary angiography [1,2]
Separate origin of the left anterior descending (LAD) and left circumflex (LCx) was the most common anomaly, occurring in 0.41% of the population followed by the circumflex artery arising from the right sinus of valsalva or from the right coronary artery (RCA) which occurs in 0.37% of the population
Wilkins et al [3] reviewed 10,000 patients who had undergone coronary angiography and found the most common anomaly to be circumflex coronary artery originating from the RCA or the right sinus of valsalva
Summary
Anomalies of the coronary arteries have been found in 1-2% of patients undergoing coronary angiography [1,2]. Wilkins et al [3] reviewed 10,000 patients who had undergone coronary angiography and found the most common anomaly to be circumflex coronary artery originating from the RCA or the right sinus of valsalva. An echocardiogram showed normal systolic function and mild (grade 1) diastolic dysfunction but no significant regurgitant or stenotic valvular lesions Given his symptoms and high cardiovascular risk profile, coronary angiography was performed which revealed twin circumflex coronary arteries as described. The second anomalous circumflex artery and the RCA originated from a common trunk arising from the right coronary cusp (Figure 1B).The RCA were non-dominant with no significant disease. In view of the patient’s non-obstructive coronary artery disease and retro-aortic course confirmed by MDCT angiography, decision was made to continue medical management alone
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