Abstract
A 55-year-old female known case of essential hypertension and diabetes was brought to the Emergency Department in a drowsy state with cardiogenic shock. At presentation systolic BP was 70 mm Hg, pulse rate was 44/min and random blood sugar was 239 mg/dl. Troponin I was 8.07. Electrocardiography showed junctional rhythm and bradycardia. Ejection Fraction (LVEF) was 15% - 20%. Coronary angiography was done which revealed single vessel disease in LAD with anomalous origin of RCA from midsegment of LAD. Patient was immediately taken up for Off-pump Coronary Artery Bypass Grafting (OPCAB). Right saphenous vein graft was harvested and anastomosed proximally to aorta and distally to LAD on beating heart using Medtronic Octopus heart stabilizer and coronary shunts. Wound closed in layers after achieving complete hemostasis. Patient was taken off ventilatory support on first post-operative day and discharged in a stable condition on fourth post-operative day. Post-operative Echocardiography showed LVEF increased from 15% - 20% at time of admission to 38% and 52% after 3 months and 12 months of surgery respectively.
Highlights
Origin of right coronary artery (RCA) from left anterior descending coronary artery (LAD) is one such anomaly which at times can lead to myocardial ischaemia even in the absence of atherosclerosis [2]
Incidence of anomalous RCA originating from LAD ranges from 0.024% to 0.066% and is often detected on coronary angiography [2]
Most commonly anomalous RCA courses between the great vessels causing external compression and ischemic symptoms, patients usually present with chest pain, dyspnea, palpitations, ventricular fibrillation, myocardial infarction, syncope or even sudden death [2] [4]
Summary
Most commonly anomalous RCA courses between the great vessels causing external compression and ischemic symptoms, patients usually present with chest pain, dyspnea, palpitations, ventricular fibrillation, myocardial infarction, syncope or even sudden death [2] [4]. We present a case of a 55-year-old female who presented in a state of cardiogenic shock and on angiography was found to have single vessel disease in LAD with anomalous origin of RCA from midsegment of LAD. She was taken up for immediate off-pump revascularization instead of PTCA, because compression of anomalous RCA between great vessels could not be ruled out on preoperative coronary angiogram (Table 1)
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