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B Bourlond1, M Dupré1, S D Qanadli2

  • 1Department of cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.

Annales De Cardiologie Et D'Angeiologie
|November 9, 2024
PubMed
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Complex coronary artery abnormalities (CAA) can be asymptomatic and clinically silent. Ischemia in patients with CAA may stem from atherosclerosis, not the congenital anomaly, suggesting non-intervention as a potential management option.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Interventional Cardiology

Background:

  • Complex coronary artery abnormalities (CAA) are rare congenital conditions with unclear management guidelines for asymptomatic individuals.
  • Current literature lacks established protocols for addressing CAA in patients without symptoms.

Observation:

  • A 49-year-old male with no prior medical history was incidentally diagnosed with two complex CAA during acute coronary syndrome management.
  • Diagnostic imaging revealed an ectopic right coronary artery (RCA) with an inter-arterial course and a retro-pulmonary left anterior descending artery originating from the RCA.
  • The patient's acute coronary syndrome was attributed to atherosclerosis, unrelated to his congenital coronary anomalies.

Findings:

  • The patient remained asymptomatic with normal echocardiography at 48-month follow-up, despite the inherent risks associated with CAA.
Keywords:
Acute coronary syndromeAngiographie coronaireAnomalie complexe des coronairesAnomalie des coronairesCase reportComplex coronary artery anomalyCoronary abnormalitiesCoronary angiographyCoronary computed tomographyScanner coronarienSyndrome coronarien aigu

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  • Congenital complex CAA can remain clinically silent for extended periods.
  • Ischemia in patients with CAA is not exclusively caused by the underlying congenital anomaly.

    • Implications:

    • This case suggests that non-correction of CAA may be a viable management strategy in asymptomatic adult patients.
    • The findings challenge the assumption that all CAA require surgical or interventional correction, especially when asymptomatic.
    • Further research is warranted to determine optimal long-term management strategies for complex CAA in asymptomatic individuals, considering the risk of sudden cardiac death and myocardial infarction.