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Supreme dominance of right coronary artery in a patient with typical angina

A Shaheer Ahmed1, Nirmal Ghati1, Gautam Sharma1

  • 1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

BMJ Case Reports
|July 29, 2019
PubMed

Insights

A rare coronary anomaly presented as absent left main coronary artery, with all branches arising from a single right coronary artery. This super dominant vessel required careful management with optimal medical therapy for symptomatic relief.

Area of Science:

  • Cardiology
  • Anatomical Variations
  • Interventional Cardiology

Background:

  • Congenital coronary artery anomalies are rare but can lead to significant cardiovascular events.
  • An absent left main coronary artery is an exceptionally uncommon anomaly.

Observation:

  • A 50-year-old woman presented with Canadian Cardiovascular Society grade III angina.
  • Coronary angiography revealed an absent left main coronary artery originating from the left coronary sinus.
  • A single right coronary artery (RCA) exhibited a super dominant course, with the left main coronary artery and left anterior descending artery arising separately from its proximal segment.

Findings:

  • The anomalous left main coronary artery and left anterior descending artery had retroaortic and prepulmonic courses, respectively.
  • A small septal branch originated independently from the proximal RCA, supplying the proximal interventricular septum.
  • The patient's anatomy represented a unique variation of coronary artery origin and course.

Implications:

  • Understanding such rare anomalies is crucial for accurate diagnosis and appropriate management.
  • Optimal medical therapy can be effective in managing symptoms associated with complex coronary artery anomalies.
  • This case highlights the importance of detailed coronary angiography in identifying unusual cardiac anatomy.

Keywords:
cardiovascular medicineclinical diagnostic testsradiology (diagnostics)

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