Right Coronary Artery Anomalous Origin from Left Anterior Descending Artery Detected by Computed Tomography Coronary Angiogram: A Case Report and Review of the Literature

Abstract

Coronary anomalies are generally rare and recognized in approximately 1.3% of coronary angiograms. The right coronary artery originating from the left coronary system is an extremely rare variation of the single coronary artery anomaly in which the prognosis is usually benign provided that the anomalous vessel does not pass between the aorta and the pulmonary artery. Right coronary artery anomaly can be associated with other congenital cardiovascular anomalies such as bicuspid aortic valve, transposition of the great vessels and tetralogy of Fallot. The clinical significance of coronary anomalies is usually determined by underlying anatomic features of the anomalous coronary origin and/or coronary atherosclerosis. Initial presentations include: chest pain, myocardial infarction, arrhythmias, sudden death, and quite rarely exertion syncope. Although coronary angiography is an important diagnostic method, new non-invasive methods such as coronary computed tomography angiography and cardiac magnetic resonance imaging have important roles to play in characterizing this coronary anomaly. It should be noted that the management strategy of these patients may vary based on clinical presentation and anatomical details. We report a Case of exertion dizziness, diagnosed to have anomalous origin of right coronary artery from left anterior descending artery diagnosed by computed tomography coronary angiography. Medical treatment was effective in relieving the patient's symptoms and ischemia.