Anomalous origin of right coronary artery with interarterial course revealed by effort angina: case report
Hind Regragui1, Badre El Boussaadani1, Chakib Benajiba1
1Department of Cardiology B, Mohammed V University, Ibn Sina University Hospital Center, Rabat, Morocco.
Insights
Anomalous coronary artery origin, a rare congenital heart defect, can cause myocardial ischemia due to compression between great arteries. This case highlights a variant requiring careful management and follow-up, especially in athletes.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Diagnostic Imaging
Background:
- Anomalous origin of coronary arteries (AoCA) with an interarterial course is a rare congenital anomaly.
- It can lead to myocardial ischemia due to systolic compression between the great arteries.
Observation:
- A middle-aged man presented with exertional angina.
- Coronary angiography revealed an anomalous origin with a common trunk for the right coronary artery (RCA) and the circumflex artery (Cx).
- Multidetector computed tomography coronary angiography (MDCTCA) confirmed the RCA and Cx arising from a right common trunk, coursing between the aorta and pulmonary trunk.
Findings:
- Magnetic resonance imaging (MRI), exercise stress test, and myocardial perfusion scintigraphy were used to assess ischemia.
- Myocardial scintigraphy was positive, indicating ischemia.
- The patient was symptomatic only during significant exertion.
Implications:
- Anatomic variants of AoCA, particularly those coursing between great vessels, pose a risk of adverse events, including sudden death in athletes.
- Therapeutic choices are debated and depend on the specific AoCA variant and patient symptoms.
- Conservative management with regular follow-up was recommended for this symptomatic patient.
Abstract:
Anomalous origin of coronary artery with interarterial course is recognized as a rare congenital heart disease. Its main manifestation is myocardial ischemia related to systolic compression of coronary arteries positioned between the great arteries. We report a case of a middle-aged man admitted in our department for an effort angina during nordic walking. A coronary angiography was performed showing an anomalous coronary artery with a birth defect giving a right common trunk of the circumflex artery and the right coronary artery. We proceeded to a multidetector computed tomography coronary angiography (MDCTCA) to describe this variant of an anomalous coronary arteries which revealed a birth defect in the left anterior sinus of the right coronary and the circumflex artery from a right common trunk passing between the aorta and the trunk of the pulmonary arteries. Magnetic resonance imaging (MRI), exercise stress test and myocardial perfusion scintigraphy were performed in order to objectify an ischemia. Despite the positivity of myocardial scintigraphy, we recommended to our patient to limit exercise with a regular follow-up since he is only symptomatic during a major effort. There are many types of anomalous coronary arteries and the anatomic variant of a right coronary artery that course between the great vessels represents a risk of adverse event and sudden death in young athletes. The choice of therapy is controversial and depends especially on the variant of anomalous coronary artery and the symptoms.
