A rare coronary anomaly: The single left coronary artery with coronary artery fistula draining into the right ventricular outflow tract

A previously healthy 9-year-old girl was referred to us for the evaluation of a murmur on a routine clinical examination. Routine electrocardiogram and chest x-ray were normal. The cardiac enzymes were normal. Combining ultrasound and CCTA, it was confirmed that the hemodynamics of the heart was a left-to-right shunt and that RVOT stole blood from the left ventricle through the single coronary artery (SCA).     

Coronary artery fistula from the left circumflex to the coronary sinus

A 27-year-old woman, who had received mitral valve repair for mitral regurgitation resulting from infective endocarditis, was admitted for a close examination of abnormal echocardiographic findings in the left atrium. Transthoracic echocardiography showed trivial mitral regurgitation with normal left ventricular contraction and dilatation of the coronary sinus. Auscultation revealed a grade 2 continuous murmur along the left sternal border. Transesophageal echocardiography demonstrated a marked dilatation of the coronary sinus just behind the posterior wall of the left atrium and turbulent blood flow in the dilated coronary sinus. Cardiac catheterization showed no significant step-up of oxygen saturation in the right heart and normal pulmonary artery pressure. Coronary angiography revealed a markedly dilated and tortuous circumflex coronary artery connected to the coronary sinus through a fistula. A left circumflex artery with a fistulous connection to the coronary sinus is extremely rare.     

Single right coronary artery continuing as left circumflex artery and hypoplastic left anterior descending artery: a rare coronary anomaly

The occurrence of a single coronary artery (SCA) is rare in the absence of other associated anomalies of the heart and is often detected incidentally during coronary angiography. This anomaly is usually benign and various types of SCA have been described. We report a rare type of SCA originating from the right sinus of Valsalva, with the left circumflex artery (LCX) continuing from right coronary artery (RCA) and hypoplastic left anterior descending artery (LAD), which was incidentally found in a 63-year-old female presenting as unstable angina.     

A rare case of anomalous left circumflex coronary artery from the left pulmonary artery

The anomalous origin of the coronary artery in children is a rare disease. In particular, an anomalous origin of the left coronary artery from the pulmonary artery is a fatal condition in neonate with myocardial failure. A 46-month-old child with an anomalous origin of the left circumflex artery from the left pulmonary artery was detected due to asymptomatic cardiac murmur and immediately re-implantation of the left circumflex coronary artery was carried out successfully.     

Absent left circumflex coronary artery

This is the first reported case of a coronary artery anomaly in which the left circumflex artery was absent. The lateral and posterior aspects of the left ventricle were supplied by a large diagonal artery and a very long right coronary artery which continued along the atrioventricular groove. © 1994 Wiley-Liss,Inc..     

Giant torturous left circumflex artery draining to the right atrium

Coronary artery anomalies represent a diverse group of congenital disorders characterized by abnormalities of coronary arteries anatomy. We describe an extremely rare case of giant torturous left circumflex artery draining to the right atrium manifesting by palpitations and atrial fibrillation.     

Congenital circumflex coronary arteriovenous fistula with aneurysmal termination in the pulmonary artery

Coronary arteriovenous fistula is a rare congenital anomaly that is seen in 0.1 % to 0.2% of coronary angiograms. Aneurysmal formation in the fistula is even rarer. We report a case of congenital circumflex arteriovenous fistula with aneurysmal formation just near its termination in the pulmonary artery, associated with atherosclerotic left anterior descending coronary artery. The anomaly was successfully repaired.     

Rupture of aneurysmal circumflex coronary artery into the left atrium after ligation of its arteriovenous fistula.

Aneurysmal circumflex coronary artery (Cx) with fistulous connection to the coronary sinus is a rare clinical entity that usually remains asymptomatic until later in life, so the ideal therapeutic strategy is poorly defined. The timing of surgical treatment for asymptomatic patients is a big issue, and whether to leave or exclude the diffuse aneurysm in addition to ligation of the fistula is controversial, considering the native myocardial circulation. Complete surgical repair, including exclusion of a diffusely aneurysmal Cx and coronary revascularization to a graftable branch in the circumflex area combined with ligation of its fistula, is quite challenging and sometimes fatal because of a broad posterolateral myocardial infarction without revascularization caused by a lack of graftable branches. A case of diffuse aneurysmal Cx, which ruptured into the left atrium after surgical ligation of its fistulous connection to the coronary sinus, is presented. Simple ligation of the fistula, leaving a gigantic aneurysmal circumflex artery, is hazardous for later rupture and should be avoided. Therapeutic strategies for this complex disorder are discussed, including the optimal timing of surgical treatment.     

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.     

Twin circumflex arteries: a rare coronary artery anomaly

Dual origin of the circumflex artery is an extremely rare anomaly. We report a rare case of a left circumflex artery arising from the left mainstem and an anomalous circumflex artery from a separate ostium in the right coronary sinus. Both these arteries supplied the circumflex territory. The potential pathological significance of the anomaly and pitfalls of the misdiagnosis are also discussed.     

Coronary artery fistula draining into left ventricle: case report and review.

A 6-year-old boy with coronary artery fistula emptying into the left ventricle was reported. An attempt was made to outline clinical manifestations of this disease which have not yet been fully described, based on the experience of the present case and a review of 14 previously reported cases. It is concluded that clinical signs and symptoms are not specific for this anomaly and retrograde aortography is required to establish the definite diagnosis of the lesion. Authors' views are expounded as to the location of maximal intensity of the murmur, genesis of the systolic murmur and electrocardiographic features.