Anomalous Origin of the Left Coronary Artery From the Right Coronary Cusp: A Case Report

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Anatomy

Background:

• Anomalous origin of the left main coronary artery (LMCA) from the right coronary sinus is a rare congenital coronary anomaly.
• This anomaly is associated with an increased risk of adverse cardiac events, including sudden cardiac death.
• Management of coronary artery disease in patients with anomalous coronary origins can be complex.

Observation:

• A 68-year-old man presented with worsening chest pain, diagnosed as ST-elevation myocardial infarction (STEMI).
• Coronary angiography revealed significant stenosis and occlusion of the right coronary artery (RCA).
• An unexpected finding was the anomalous origin of the LMCA from the right coronary cusp, sharing a single ostium with the RCA.

Findings:

• Percutaneous coronary intervention (PCI) attempts to revascularize the occluded RCA were unsuccessful due to the complex coronary anatomy associated with the anomalous LMCA origin.
• The anatomical challenges included the shared ostium and the aberrant course of the LMCA.

Implications:

• This case underscores the significant technical difficulties encountered during revascularization procedures for anomalous coronary arteries.
• Medical management was chosen for this patient due to the failed PCI attempts.
• Further research into optimal revascularization strategies for complex coronary anomalies is warranted.