Anomalous left coronary artery from pulmonary artery. Unusual case complicated by coronary arterial disease and fistula from coronary artery to left ventricle

A 42-year-old woman with an anomalous left coronary artery originating from the pulmonary artery and a fistula from the left coronary artery to the left ventricle was treated by aortocoronary bypass grafting of an autologous saphenous vein. The presence of an abundant collateral circulation and of fistulous communications between the left coronary artery and the left ventricle, in our opinion, was the reason that this patient remained asymptomatic until the age of 40 years. We believe that this is the first report of the findings in an adult patient who had these two rare congenital anomalies complicated occlusive coronary arterial disease.     

Single coronary artery: right coronary artery originating from distal left circumflex

This report describes a patient with single coronary artery, in whom the right coronary artery originated from the distal left circumflex. However, this anomaly was not of clinical significance based on atypical nature of chest pain, negative thallium exercise test and absence of coronary obstruction.     

Mid left anterior descending coronary artery originating from the right coronary artery

Dual connection of the left anterior descending coronary artery to the left and right coronary arteries is a very rare congenital anomaly. In this report we describe two cases in which the mid-position of the left anterior descending coronary artery is connected to the right coronary artery, one directly and the second by way of the infundibular artery. To the best of our knowledge, connection of the mid-position of the left anterior descending to the infundibular artery has not been previously described.     

Anomalous origin of the left circumflex coronary artery from the right coronary artery and the left anterior descending artery from the right coronary sinus

We present the case of a 67-year-old female who was admitted to our institution because of anginal chest pain. Selective coronary angiography revealed separate ostial origins of the left anterior descending (LAD) artery and the right coronary artery (RCA) from the right coronary sinus (RCS). The left circumflex (LCx) coronary artery arose from the proximal RCA. The left anterior descending had an anterior free wall and the LCx had a retroaortic course. To our knowledge, this type of combination of anatomical variation of coronary circulation has not been described in the literature.     

Double left anterior descending artery originating from the left and right coronary artery: A rare coronary artery anomaly

A case of double left anterior descending coronary artery is presented. The double artery originated from the left main stem and the right coronary artery. There were no stenoses on these two arteries. This anomaly of coronary arteries seems to be very rare. © 1993 Wiiey-Liss, Inc.     

Double left anterior descending artery originating from the left and right coronary artery: A rare coronary artery anomaly

Coronary arteries with anomalous aortic origin are infrequently encountered in patients undergoing cardiac catheterization and pose potential technical difficulties for performing both diagnostic and angioplasty procedures. Percutaneous transluminal coronary angioplasty (PTCA) of atherosclerotic disease in anomalous right coronary artery (RCA) has been described in only a few reports. In all the cases reported to date, the anomalous vessel arose from the left sinus of Valsalva. We report a case of a technically straight-forward PTCA performed in an anomalous RCA arising from the anterior aspect of the ascending thoracic aorta. © 1994 Wiley-Liss,Inc..     

Single coronary ostium - a right coronary artery arising from the left main coronary artery

Single coronary ostium is a very rare congenital anomaly with an incidence of 0.024% in angiographic series. This is the third case of Shirani-Roberts subtype IB4: solitary ostium in the left coronary sinus associated with a retroaortic-coursing right coronary artery that arises from the left main coronary artery. The patient is a 45-year-old male with no past medical history, and who was seen in the clinic for evaluation of a murmur. Echocardiography showed rheumatic heart disease with mild mitral regurgitation and moderate aortic regurgitation; no shunts were present. Coronary and aortic root angiography did not show a vessel originating from the right coronary cusp. The right coronary artery originated from the left main coronary artery and had an aberrant course which was dorsal to the ascending aorta. No associated congenital heart disease was present.     

Anomalous origin of left coronary artery from pulmonary artery.

An anomalous origin of the left coronary artery from the pulmonary artery in a 26-year-old man was corrected by the ligation of the artery at its anomalous origin, followed by the construction of an aortocoronary bypass with a venous graft. The flow of blood to the myocardium was measured for the purpose of comparing the effect of the bypass method with that of the ligation method. The result suggested that the bypass method provided a greater flow of blood to the myocardium than did ligation alone.     

Anomalous origin of right coronary artery from left coronary sinus

Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 4 patients, aged 34 to 59 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which was surgically repaired. Three patients presented dyspnea and angina, and one with acute myocardial infarction. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.     

Anomalous left coronary artery from non-facing pulmonary sinus

A case of anomalous left coronary artery originating from the non-facing pulmonary sinus, located at the most distal position from the aorta, is described. An intrapulmonary tunnel was created without causing undue stenosis or kinking. The Takeuchi procedure is considered to be a useful surgical technique when the origin of the anomalous left coronary artery is far from the aorta.