Anomalous Origins of All Three Coronary Arteries from Separate Ostia within the Right Aortic Cusp: A Case Report and Review of the Literature

Abstract

Coronary artery anomalies are congenital defects which are found incidentally or after cardiac events. While these are rare abnormalities with the majority of patients remain asymptomatic and largely undiagnosed, it remains to be a major cause of sudden cardiac death (SCD). Anomalous origin of left coronary artery (ALCA) from the opposite right aortic sinus is extremely rare with less than 100 cases reported to-date. These patients are at increased risk for significant cardiac events, including SCD. In this report, we present a 48-year-old man with hypertension and marijuana use who was admitted initially with multi-lobar pneumonia and acute kidney injury, developed respiratory failure and sustained ST elevation myocardial infarction (STEMI). Coronary angiography demonstrated anomalous origin of all three main coronary arteries arising from right aortic sinus. In this report we also discuss the genesis of this rare and potentially fatal congenital abnormality and we highlight the diagnostic and management strategies available to-date.

A Rare Case of Anomalous Origin of Left Anterior Descending Artery From Right Coronary Ostium

“…CAA are defined as morphological, anatomical variants found in <1% of the population [ 1 ]. They are classified based on origin, course, termination, and hemodynamic significance [ 4 ]. CAA anomalies can be benign or malignant.…”

“…The LAD and LCx arising from the left sinus of Valsalva, LCx from the right sinus of Valsalva (RSV), the ectopic origin of coronaries from the posterior sinus of Valsalva (PSV), origin from ascending aorta, absent circumflex, intercoronary communication, and small coronary artery fistula is considered benign [ 2 ]. Malignant anomalies include either ectopic origin from the pulmonary artery (PA) or opposite aortic sinus, single coronary artery and large coronary artery fistulae [ 4 ]. The non-atherosclerotic mechanisms causing malignant risks include small artery, high acute take-off, compression of LAD, myocardial squeezing, and vasospasm.…”