An Obstructed Anomalous Left Anterior Descending Coronary Artery Arising from the Right Coronary Artery Requiring Surgical Intervention

Abstract

A 47-year-old female presented to our hospital with symptoms of stable angina. Cardiac catheterization revealed a rare coronary artery anomaly of the left anterior descending (LAD) artery branching off the right coronary artery ostium. Furthermore, the anomalous LAD artery exhibited significant atherosclerotic obstruction. Our review of the literature found only nine such previously described cases. Due to the unique nature of coronary artery anomalies and their complications, we would like to contribute our case to the medical literature.

A Rare Case of a Type IV Dual Left Anterior Descending Artery and Ectopic Left Anterior Descending and Circumflex Arteries Requiring Surgery

“… 5 Moreover, it has also been proposed that abnormal vascular genesis and abnormal progression may predispose an individual to atherosclerosis. 6 …”

A Case of Anomalous Left Anterior Descending Artery Originating From the Right Sinus of Valsalva

“…To the best of our knowledge, only 67 cases have been reported in the literature so far (Table 1). This anomaly should be differentiated from another anomaly in which LAD arises from the RCA, called as Type IV "dual LAD" anomaly, whose incidence is 0.01%-0.03% [10]. The majority of the CAAs are detected incidentally, and their clinical significance remains controversial.…”

“…The majority of the CAAs are detected incidentally, and their clinical significance remains controversial. However, it has been postulated that an aberrant origin and the anomalous course could make them more prone to atherosclerosis [10]. Although CAAs are usually asymptomatic, they may present with angina, dyspnea, palpitations, syncope, cardiac arrest, and sudden cardiac death (SCD).…”

“…CAAs are also the second most leading cause of SCD in athletes at 19% as compared to hypertrophic cardiomyopathy at 36% [12]. Other anatomic characteristics of CAAs predisposing them to grave outcomes include single coronary artery, origin from the pulmonary artery or opposite aortic sinus, intramural course, acute angle takeoff and ostial stenosis or atresia [2][3][4]6,10]. Asymptomatic CAAs rarely need interventions; however, symptomatic individuals with a malignant course often require surgical correction [8].…”