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Unusual dominant course of left circumflex coronary artery with absent right coronary artery
  1. W C Kang,
  2. S H Han,
  3. T H Ahn,
  4. E K Shin
  1. kangwch{at}gilhospital.com

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A single coronary artery is an unusual congenital anomaly where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. We describe here a rare case with an unusual dominant left circumflex artery and no right coronary artery.

A 43 year old man presented with atypical chest pain. His physical examination was unremarkable except for a blood pressure of 180/100 mm Hg. The ECG showed normal sinus rhythm without any ischaemic ST-T changes, and the treadmill exercise test also showed no evidence of ischaemia. Selective coronary angiography showed a normal left main coronary artery originating from the left sinus of Valsalva. However, the left circumflex coronary artery was a very dominant vessel and continued along the entire right side of the heart as the right coronary artery (panels A–C). There was no separate ostium for the right coronary artery as evident in the aortic root angiogram (panel D). There was no stenosis of any of the coronary arteries. The patient was discharged with antihypertensive medication.

Most coronary anomalies are accidentally identified during selective angiography. The separate origin (“absent left main”) of the left anterior descending artery and left circumflex artery (30.4%) and anomalous left circumflex artery (27.7%) have been identified as the two most common coronary anomalies. Anomalous origin of the right coronary artery is also relatively common and has been described from various sites including the pulmonary trunk, aorta, left ventricle, and the sinus of Valsalva. However, continuation of the left circumflex artery along the entire right side of the heart with the absence of the right coronary artery, as occurred in our case, has never been described before. No regional wall motion abnormality was noted on echocardiogram and no collateral circulation from left to right was observed. These findings excluded the possibility of right coronary artery obstruction at its origin from the aorta.


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Selective left coronary angiogram in anteroposterior (AP) caudal view (A), left anterior oblique (30°) view (B), and AP cranial view (C). It shows that the left circumflex artery is very dominant and continues along the entire right side of the heart as the right coronary artery (white triangle). (D) Aortic root angiogram showing there is no separate ostium for the right coronary artery. LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery.

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