Congenital absence of left circumflex artery with a dominant right coronary artery

Area of Science:

• Cardiology
• Human Anatomy
• Vascular Biology

Background:

• Congenital coronary artery anomalies are rare but can lead to significant cardiovascular events.
• The absence of the left circumflex artery (LCX) is an uncommon anomaly with potential clinical implications.
• Accurate diagnosis is crucial for appropriate patient management and risk stratification.

Purpose of the Study:

• To report two cases of adult male patients presenting with symptoms suggestive of coronary artery disease.
• To highlight the diagnostic findings of congenital absence of the left circumflex artery (LCX) via coronary angiography.
• To discuss the clinical presentation and potential management of this rare coronary anomaly.

Main Methods:

• Detailed review of clinical presentations, including post-myocardial infarction angina and chest pain.
• Coronary angiography and aortography were performed to visualize coronary anatomy.
• Intraoperative findings were used to confirm angiographic diagnoses.

Main Results:

• Case 1: A 40-year-old man with total occlusion of the left anterior descending artery (LAD) and retrograde filling of the LAD by the right coronary artery (RCA), with confirmed absent LCX.
• Case 2: A 39-year-old man with a normal LAD, absent LCX system, and a superdominant RCA, confirmed by aortogram.
• Both patients demonstrated the congenital absence of the left circumflex artery (LCX).

Conclusions:

• Congenital absence of the left circumflex artery (LCX) is a rare coronary anomaly.
• This anomaly can be associated with significant coronary artery disease, including myocardial infarction.
• Comprehensive coronary angiography is essential for diagnosing absent coronary arteries and guiding treatment.