Abstract
We present a case of a rarely seen anomalous circumflex (C x) artery originating from the proximal right coronary artery. This was an incidental finding during a diagnostic coronary angiogram performed to investigate a patient with acute coronary syndrome. Surgically significant disease was present in four left-sided vessels. The patient underwent coronary artery bypass grafts using left internal thoracic artery and long saphenous vein grafts to all four left sided vessels including the aberrant C x. We also present a discussion of current relevant literature and guidelines in relation to definition, classification, incidence, diagnosis, clinical relevance and treatment of this type of coronary artery anomalies.
Highlights
A 64-year-old Caucasian male presented to our hospital with new, sudden onset, chest pain and shortness of breath
We present a case of a rarely seen anomalous circumflex (Cx) artery originating from the proximal right coronary artery
We present a discussion of current relevant literature and guidelines in relation to definition, classification, incidence, diagnosis, clinical relevance and treatment of this type of coronary artery anomalies
Summary
A 64-year-old Caucasian male presented to our hospital with new, sudden onset, chest pain and shortness of breath. Transthoracic echocardiography demonstrated basal-inferior hypokinesis, normal mitral and aortic valves and preserved left ventricular (LV) systolic function. Coronary angiography revealed a right dominant system with normal left main stem. Significant disease was present in the proximal and mid parts of the left anterior descending (LAD), diagonal (Dx) and intermediate (Int) arteries. The circumflex (Cx) artery had aberrant origin from the proximal right coronary (RCA) artery with severe proximal/mid vessel disease (Figure 1). It coursed behind the aorta and pulmonary artery. The RCA did not have surgically significant disease. Left internal thoracic artery was anastomosed to the LAD, long saphenous vein was used for grafts to Dx, Int and OM. Postoperative course was uneventful and the patient was discharged home after eight days
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