Percutaneous Occlusion of Anomalous Circumflex From Pulmonary Artery Treating Coronary Steal and Left Ventricular...

Anomalous origin of the left circumflex artery (LCx) from the pulmonary artery (ACxAPA) is rare. We report a case of successful percutaneous occlusion.

A 74-year-old man presented with progressive dyspnea on exertion. Echocardiography showed a left ventricular ejection fraction of 45% with inferior hypokinesis. Nuclear imaging revealed an inferior perfusion defect. Coronary computed tomography angiography demonstrated an anomalous LCx originating from the right pulmonary artery. Right heart catheterization and coronary angiography confirmed the diagnosis. Injection of the coronary arteries revealed retrograde filling of the LCx with drainage into the right pulmonary artery. After multidisciplinary discussion, percutaneous closure was pursued. Using femoral venous access, an 8-mm vascular plug was deployed at the origin of the anomalous artery, with complete occlusion of the ostium. Left ventricular ejection fraction improved immediately, and this improvement was sustained.

Although the literature on ACxAPA is sparse, this case indicates that transcatheter occlusion can be effective in carefully selected adults.

Recognizing and documenting ACxAPA is essential. Management should be individualized by a heart team; percutaneous occlusion is an option when anatomy is favorable.