Right coronary artery originating from distal left circumflex: an unusual feature of single coronary artery

This report describes a patient with a single coronary artery system, in whom the right coronary artery originated from the distal left circumflex. A significant stenosis was present just at the take-off of the aberrant right coronary artery. No other associated cardiac anomaly could be demonstrated; the patient was referred for elective bypass surgery.     

Right coronary artery originating from distal left circumflex: an extremely rare variety of single coronary artery

Single coronary artery is a rare congenital anomaly of the coronary circulation which is often associated with other congenital cardiac malformations. Right coronary artery arising from the distal left circumflex artery is an extremely rare variety of single coronary artery. We report a patient with a single coronary artery system, in whom the right coronary artery originated from the distal left circumflex. No other associated cardiac anomaly was detected.     

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.     

Anomalous right coronary artery originating from the distal left circumflex artery: single coronary artery with choronic atrial fibrillation

This report describes a patient with a single coronary artery in whom the right coronary artery originated from the distal left circumflex artery. Single coronary artery is a rare congenital anomaly of the coronary circulation which is often associated with other congenital cardiac malformations. This anomaly is thought to be clinically significant especially in patients with atrial fibrillation, although no other associated cardiac anomaly was detected.     

Acute myocardial infarction of the right coronary artery originating from the distal left circumflex artery

A case of acute myocardial infarction (AMI) of the distal left circumflex, near the origin of an aberrant right coronary artery is presented. Coronary stenting was successfully performed. According to several reports, this anomaly is a common site for coronary atherosclerosis, but this is the first report of AMI.     

Single left coronary artery with origin of the right coronary artery from distal circumflex

We report two very unusual cases of agenesis of the right coronary ostium with continuation of the left circumflex artery as the right coronary artery. The recognition of the anomaly in the first case lead to a better understanding of this finding in the second case, which translated into shorter procedure time, less contrast volume, and fewer catheter manipulations.     

An unusual coronary trinity: single left coronary artery with the right coronary artery originating from the left main coronary artery and following a retro-aortic course

All three coronary arteries originating from a single coronary ostium is a rarity. Single coronary artery (CA) arising from the left aortic sinus is far more uncommon than one arising from the right sinus. Usually in such cases, the right coronary artery (RCA) arises as a distal continuation of the left circumflex artery. We describe an extremely uncommon anatomic variant, where the RCA arose from the single undivided CA as a branch of the left main coronary artery and followed a retro-aortic course before reaching its designated anatomic territory.     

Left internal mammary-to-left circumflex coronary artery collateral pathway in a patient with occluded left circumflex artery

A unique case of left internal mammary artery-to-circumflex coronary artery collateral pathway, which was conceivably encouraged to develop by coronary occlusion. The pathway provided sufficient collateral perfusion to preserve the local myocardial performance.     

An unusual congenital coronary anomaly: origin of the left circumflex coronary artery from a right coronary artery arising from the left sinus of valsalva

A 54-year-old male was admitted to our department for stable angina. Coronary angiography and 16-slice computed tomography revealed an abnormal origin of the right coronary artery from the left sinus of Valsalva, coursing between the aorta and the pulmonary trunk and then giving origin to the left circumflex coronary artery. A severe stenosis was present in the middle segment of the right coronary artery, which was successfully treated by stent implantation.     

Right heart bypass for left circumflex coronary artery bypass grafting

Displacement of the heart to expose the left circumflex artery (LCX) causes hemodynamic disturbance during off-pump coronary artery bypass grafting (CABG). We applied right heart bypass (RHB) using a heparin-coated centrifugal pump without an oxygenator in an attempt to stabilize the hemodynamics. Five mongrel dogs (15.5–20 kg) were used. Hemodynamic parameters were continuously monitored at a fixed rate of 80 beats/min. The LCX was exposed with the use of an Octopus Tissue Stabilizer. After baseline data were obtained, each dog was placed in the Trendelenburg position. Finally, RHB was established with different pump flows. LCX exposure caused a significant decrease in aortic flow (to 33.1% ± 13.1% of the baseline value) and arterial mean pressure (to 68.3% ± 8.5%) (P < 0.001). Trendelenburg positioning caused these values to recover to 57.1% ± 6.7% and 72.5% ± 7.7%, respectively. RHB with 50% flow significantly improved the hemodynamic values, although 100% flow significantly increased LAP by 134.8% ± 19.7% (P < 0.01). Tilting of the canine heart to expose the LCX caused significant deterioration of the hemodynamic values. Trendelenburg positioning was moderately effective, and RHB very effective, in improving the hemodynamics. In a limited number of cases, an appropriate flow of RHB may provide safe hemodynamic assistance during off-pump CABG of the LCX. Received: March 10, 2000 / Accepted: May 27, 2000     

Stenting of an anomalous left circumflex coronary artery arising from the right coronary artery

Coronary angioplasty can provide excellent means of revascularization of anomalous coronary arteries. Successful application of angioplasty to these vessels requires angiographic knowledge of their course, structure and appropriate equipment selection. Advancement of stent delivery systems in such cases requires good support with the possibility of selective cannulation and deep engagement of the guiding catheter. We report a case of stent placement in an anomalous circumflex artery arising from the right coronary artery.     

Congenital absence of left circumflex coronary artery presented with vasospastic angina and myocardial bridge in single left coronary artery

Congenital absence of left circumflex coronary artery (LCX) is a very rare congenital anomaly of the coronary circulation, and few cases have been reported in the literature. We report a case of a 48-year-old male who had congenital absence of LCX presented with vasospastic angina. Routine coronary angiography showed congenital absence of the LCX, typical myocardial bridge in the mid left anterior descending coronary artery (LAD) and super-dominant right coronary artery (RCA). The dominant LAD showed a spastic appearance at the baseline coronary angiography and significant spasm was induced by incremental intracoronary acetylcholine (ACh) provocation test at mid LAD where the myocardial bridge site was observed and was extended to the distal LAD. Typical anginal chest pain was documented during the Ach provocation test and the patient was stabilized with conventional anti-anginal medication. Precise morphological and functional evaluation of the anomalous coronary artery is important for selecting the best treatment modality and better prognosis.     

Computed tomography coronary angiographic demonstration of a single coronary artery with the right coronary artery arising as a continuation from the left circumflex coronary artery.

We present the case of a 31-year-old man undergoing a chest pain evaluation. This report illustrates how 64-slice computed tomographic coronary angiography (CTCA) can aid in the management of patients with equivocal stress test results. It also describes how CTCA can accurately determine the origin and course of an anomalous coronary artery.     

False positive retroaortic left circumflex coronary artery in a patient with atrial septal defect

Retroaortic course of coronary artery is a relative contraindication for device closure of an atrial septal defect. In this brief report, we demonstrate, for the first time, inferior aortic recess mimicking retroaortic left circumflex coronary artery in a patient with atrial septal defect. This distinction is important to avoid spurious diagnosis of anomalous coronary artery denying patient a chance of nonsurgical closure of atrial septal defect.