Abstract
BackgroundAn aberrant origin of the left coronary artery (LCA) from the right coronary cusp (RCC) is an extremely rare congenital anomaly. We here report on successful percutaneous coronary intervention (PCI) in a patient presenting with acute coronary syndrome and an aberrant origin of the LCA from the RCC.Case presentationA 50-year-old man presented at our emergency department with recurrent resting chest pain. Following unsuccessful attempts at visualizing the left coronary artery using Judkins left and Amplatz catheters, an aortogram using a pigtail catheter suggested anomalous left coronary artery origin and showed a significant occlusive lesion at proximal left anterior descending artery. A Judkins right 4 guiding catheter was placed around the left coronary ostium and exchanged for a Judkins left 3.5 guiding catheter after introducing a .014" coronary long wire into the left circumflex artery. With excellent angiographic visualization and guide support, a drug-eluting stent was then successfully implanted. Cardiac computed tomography (CT) demonstrated left coronary artery origin from right coronary cusp.ConclusionThis report presents a case of LCA originating from the RCC accompanied with acute coronary syndrome that was treated with successful PCI.
Highlights
An aberrant origin of the left coronary artery (LCA) from the right coronary cusp (RCC) is an extremely rare congenital anomaly
This report presents a case of LCA originating from the RCC accompanied with acute coronary syndrome that was treated with successful percutaneous coronary intervention (PCI)
We report on successful percutaneous coronary intervention (PCI) in a patient with acute coronary syndrome and LCA originating from the RCC
Summary
Coronary artery anomalies are rare findings in about 1% to 2% of adults [1], with aberrant origin of the left coronary artery (LCA) from the right coronary cusp (RCC) being extremely rare (0.15% incidence) [2]. An electrocardiography showed normal sinus rhythm without significant ST-T wave abnormality, and chest X-ray findings were unremarkable. His serum troponin I peaked at 0.09 mcg/L (ULN ≤0.05 mcg/L) within 24 h of presentation. Left main coronary artery could not be engaged with conventional diagnostic catheters, such as Judkins Left 4 and Amplatz 1.0, and nonselective angiography using pig-tail catheter raised suspicion that the left coronary artery (LCA) was originating from the right coronary cusp (RCC) with an up-to90% occlusive lesion present at the proximal left anterior descending artery (LAD) (Fig. 1a). Two days later, computed tomography coronary angiography to establish the LCA system course revealed an anomalous origin of LAD and LCx from the right sinus of Valsalva (Fig. 2)
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