Congenital Absence of the Left Circumflex Artery Associated with Inferior Myocardial Infarction

Abstract

Congenital absence of the left circumflex artery is a rare anomaly of the coronary arteries. A 52-year-old man who developed acute inferior myocardial infarction underwent coronary angiography which revealed the absence of the left circumflex artery and that the surrounding structures were supplied by the infarct-related super-dominant right coronary artery. Two stents were implanted into the right coronary artery and one stent into the mid portion of the left anterior descending artery. Follow-up coronary angiography at 67 months showed no detectable restenosis, and 64-slice multidetector computed tomography confirmed the absence of the left circumflex artery. The circumflex artery as a terminal extension of a culprit right coronary artery has not been previously reported.

Role of MDCT - Coronary Angiography in the Evaluation of Coronary Artery Anomalies and Incidence of Coronary Artery Anomalies in a Subset of South Indian Population

“…(7) Congenitally absent left circumflex artery is an extremely rare anomaly of coronary arteries with only a small number of cases having been reported, but its incidence is increasing due to the wide use of MDCT Coronary angiography. (8,9) (Fig. 1).…”

“…2) and do not necessitate intervention. (8) Anomalies involving the right coronary artery or the left main coronary artery also can occur. Some variants, such as anomalous right coronary artery following an interarterial course between the aorta and the right ventricular outflow tract are considered malignant variant and are associated with myocardial ischemia with increased morbidity and mortality, and are often treated with surgical reimplantation or coronary artery revascularization.…”

Incidentally Detected Congenitally Absent Left Circumflex Artery by MDCT Coronary Angiogram

“…[4] Congenitally absent left circumflex artery is an extremely rare anomaly of coronary arteries with only a small number of cases having been reported, but its incidence is increasing due to the wide use of MDCT coronary angiography. [5,6] The incidence of congenitally absent left circumflex artery is between 0.003% to 0.067%. [5,6] Usually, in these cases the lateral wall of the left ventricle is supplied by the right coronary artery branches like in our case or by diagonals from left anterior descending artery.…”

“…[5,6] The incidence of congenitally absent left circumflex artery is between 0.003% to 0.067%. [5,6] Usually, in these cases the lateral wall of the left ventricle is supplied by the right coronary artery branches like in our case or by diagonals from left anterior descending artery. Congenital absence of left circumflex artery is an incidental benign finding on coronary angiography and most of these patients present with chest pain on exertion.…”

Clinical Implications of Congenital Absence of Circumflex Coronary Artery

“…5 However, an acute coronary syndrome related to a coronary anomaly has a more serious progression because of the extensive territory to which blood is supplied. 7,8 Moreover, percutaneous coronary intervention for a coronary anomaly is a challenging procedure because of the complex anatomy and higher associated clinical risk which necessitates the expertise of an experienced interventional cardiologist. 9 Several case presentations have demonstrated different clinical pictures in the congenital absence of the CX.…”