Abstract
BackgroundWoven coronary artery (WCA) is an extremely rare congenital anomaly in which a part of epicardial coronary artery is divided into thin channels, that twist along the axis of the coronary arteries and then merge again as the main coronary lumen. This anomaly is regarded as a benign condition because the blood flow is normal. Very few cases of WCA have been reported.Case presentationHerein we report a case of a 44-year-old man who was admitted to our hospital due to 20 years of repeated episodes of heart palpitations, 2 years of shortness of breath after activity, and the symptoms were aggravated for 1 month. He had history of inferior myocardial infarction and atrial fibrillation. Color Doppler echocardiography revealed rheumatic heart disease, severe mitral regurgitation, mild-moderate tricuspid regurgitation, moderate pulmonary hypertension. Coronary angiography revealed 60–85% diffuse stenosis in the middle of left anterior descending artery, 60–90% diffuse stenosis in the middle of left circumflex artery, 30–40% diffuse stenosis in the proximal segment of right coronary artery, and WCA anomaly in the middle, and distal segments of right coronary artery.ConclusionThe patient successfully underwent prosthetic valve replacement and left anterior descending coronary artery bypass grafting, and had a good recovery after surgery. Further studies are needed to fully understand the disease and determine appropriate treatment options.
Highlights
Woven coronary artery (WCA) is an extremely rare congenital anomaly in which a part of epicardial coronary artery is divided into thin channels, that twist along the axis of the coronary arteries and merge again as the main coronary lumen
The malformation comprises an epicardial coronary artery that is divided into many thin channels that twist along the axis of the coronary artery and merge to form the main lumen
WCA occurs more frequently in men than in women, with the onset concentrated at 39–78 years of age, WCA was reported in a 9-month-old male infant who was diagnosed with Kawasaki disease [2]
Summary
It is generally considered benign, interventional cardiologists should keep this anomaly in mind and correctly identify it, especially when coronary artery filling defects are observed, and coronary flow in the distal segments is normal. Angiographic images from multiple projections should be obtained and carefully analyzed. OCT or intravascular ultrasonography should be performed to avoid a missed or incorrect diagnosis and to reduce the occurrence of complications associated with unnecessary interventional procedures. The patient underwent successful prosthetic valve replacement and left anterior descending coronary artery bypass grafting. Because of the very low incidence of WCA, few studies have focused on its treatment. Further studies are needed to fully understand the disease and determine appropriate treatment options
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