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Updated: Mar 23, 2026

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Left Main Coronary Artery Hypoplasia in Elderly

Selma Kenar Tiryakioglu1, Hakan Ozkan2, Hakan Bahadir1

  • 1Department of Cardiology, Bursa State Hospital, Bursa, Turkey.

Case Reports in Cardiology
|April 6, 2016
PubMed

Insights

Congenital coronary artery anomalies can cause coronary occlusive disease. This case highlights a rare anomaly where hypoplastic left coronary arteries made surgical intervention inappropriate for angina.

Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Congenital Heart Disease

Background:

  • Congenital anomalies of the coronary arteries are a diverse group of conditions that can lead to coronary occlusive disease.
  • These anomalies can present with varied clinical manifestations, including ischemic cardiac symptoms.
  • Coronary angiography remains a key diagnostic tool for evaluating coronary artery anatomy and function.

Purpose of the Study:

  • To report a rare case of congenital coronary artery anomaly presenting as ischemic symptoms.
  • To illustrate the diagnostic process using coronary angiography in a patient with atypical cardiac presentation.
  • To discuss the management challenges and treatment decisions for such anomalies.

Main Methods:

  • Coronary angiography was performed in a 67-year-old woman presenting with angina and non-diagnostic exercise testing.
  • Detailed anatomical assessment of the coronary arteries was conducted.
  • Multidisciplinary discussion involving cardiology and cardiovascular surgery was held to determine the optimal treatment strategy.

Main Results:

  • Coronary angiography revealed a congenital anomaly characterized by hypoplasia of the left anterior descending and circumflex arteries.
  • The left main coronary artery originated from the normal anatomical position.
  • Coronary artery bypass surgery was deemed inappropriate due to the severe hypoplasia of the entire left coronary system.

Conclusions:

  • Congenital hypoplasia of the left coronary system is a rare anomaly that can mimic obstructive coronary artery disease.
  • Accurate anatomical diagnosis via coronary angiography is crucial for appropriate treatment planning.
  • Surgical intervention may not be feasible in cases of extensive hypoplasia, necessitating alternative management strategies.

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