Aberrant Right Coronary Artery from the Left Coronary Sinus Presenting with Inferior Wall Myocardial Infarction
Saket Satyasham Toshniwal1, Satyasham S Toshniwal2, Sunil Kumar1
1Department of General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India.
Insights
A rare case of coronary artery disease involved an abnormally arising right coronary artery (RCA) originating from the left coronary cusp. This unusual coronary anomaly presented with significant stenosis, highlighting diagnostic challenges.
Area of Science:
- Cardiology
- Radiology
Background:
- Coronary arteries typically originate from the aortic sinuses.
- Abnormal coronary artery origins are rare, with low prevalence and incidence.
- Diagnosis of anomalous coronary arteries can be challenging with routine investigations.
Observation:
- A 68-year-old male presented with anginal chest pain.
- Coronary angiography revealed coronary artery disease with an abnormally arising right coronary artery (RCA).
- The RCA originated from the left coronary cusp and had a proximal stenotic lesion.
Findings:
- The anomalous origin of the RCA was confirmed by multidetector computed tomography (MDCT) with 3D reconstruction.
- This case represents a rare instance where the anomalous vessel itself was the culprit lesion.
- The patient's condition highlights the importance of advanced imaging in diagnosing complex coronary anomalies.
Implications:
- Accurate diagnosis of anomalous coronary arteries is crucial for effective management.
- MDCT with 3D rendering is valuable for visualizing complex coronary artery anatomy.
- This case contributes to the limited literature on abnormally arising coronary arteries and their clinical significance.
Abstract:
Coronaries arise normally from the aortic sinus which consists of one anterior and two posterior cusps of which the right coronary artery (RCA) arises from the anterior cusp and the left coronary artery arises from the left posterior cusp. Abnormal origin of coronary arteries is very rare and counts for about 2.33% of prevalence and below 1% incidence and are comparatively very difficult to diagnose through routine investigations. Till date, only one case has been reported in the literature where the culprit vessel was the victim as seen in our case. We report a case of a 68-year-old male, who underwent coronary angiography for his anginal chest pain, was diagnosed with coronary artery disease with an "abnormally arising RCA" from the left coronary cusp with a proximal stenotic lesion in the anomalously arising RCA, which was confirmed on multidetector computed tomography three-dimensional reconstruction volume-rendered imaging.
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