Anomalous origin of the left circumflex coronary artery: is surgery required? A case report
William Murray1, Ros Lavery1, Jim O'Brien1
1Department of Cardiology, Mater Private Network, Eccles Street, Dublin D07WKW8, Ireland.
Insights
A rare congenital heart anomaly, the left circumflex artery originating from the pulmonary artery, was identified in a 26-year-old male presenting with ventricular arrhythmias. Conservative management was chosen over surgical correction for this unusual coronary artery distribution.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Imaging
Background:
- Congenital coronary artery anomalies are well-documented but rare.
- The left circumflex artery (LCx) arising from the pulmonary artery is an exceptionally uncommon deviation.
Observation:
- A 26-year-old male with prior cardiac surgery presented with ventricular flutter and arrhythmias.
- Diagnostic imaging, including CT angiography and coronary angiography, revealed the LCx originating from the pulmonary artery.
- The patient experienced broad-complex tachycardia refractory to medical management, necessitating cardioversion.
Findings:
- The patient was diagnosed with an anomalous left circumflex artery originating from the pulmonary artery.
- He underwent successful implantation of a subcutaneous pacemaker.
- Despite potential risks, a multidisciplinary team opted for conservative management instead of surgical correction.
Implications:
- Aberrant coronary anatomy presents varied clinical outcomes, necessitating individualized treatment strategies.
- Further research is crucial to guide clinical decision-making and optimize patient care for these rare conditions.
- This case highlights the importance of comprehensive cardiac evaluation and tailored management plans for anomalous coronary arteries.
Background:
Deviations from usual coronary artery anatomy are well documented. The left circumflex artery (LCx) arising from the pulmonary artery is an example of one such deviation which is rarely seen. We present the case of a 26-year-old male with this coronary artery distribution presenting with an episode of ventricular flutter with late gadolinium enhancement and pluri-morphological ventricular arrhythmias.
Case Summary:
A 26-year-old male with a history of cardiac surgery presented to his local hospital with an episode of symptomatic broad-complex tachycardia (BCT). It failed to revert to sinus rhythm following intravenous beta-blockers and amiodarone and required external cardioversion. Subsequently, the patient developed a aspiration pneumonia requiring ICU admission, after which he was transferred to our institute for ongoing cardiac management. Cardiac computed tomography CTA and coronary angiography revealed that the LCx was found to originate from the pulmonary artery. He underwent insertion of a subcutaneous pacemaker and was subsequently discharged. Despite the potential for steal syndrome of viable coronary territories. Multidisciplinary team discussion determined him to be fit for conservative management and not for surgical correction of his anomalous coronary artery anatomy.
Discussion:
Aberrant coronary artery anatomy can lead to diverse outcomes for patients in terms of both morbidity and mortality. The need for surgery in these situations varies on a case-by-case basis and little research exists to guide decision-making for healthcare professionals. As such there is a need for further study both to guide treatment and to ensure high-quality outcomes for patients with this condition.
