Successful percutaneous coronary angioplasty in a patient with anomalous origin of the right coronary artery from the left anterior descending artery

Anomalous right coronary artery originating from the left anterior descending artery: Case report and review of the literature

“…Several previous authors state such an anomaly is usually benign [16,34,39] and that there appears to be no increased incidence of coronary artery disease in such patients [19]. Cases reported to date may suggest the converse to be true.…”

“…Cases reported to date may suggest the converse to be true. Of 35 cases of anomalous RCA with origin from the LAD in structurally normal hearts (including the current case),19 patients had N 50% narrowing in one or more epicardial coronary arteries (54%) [16,22,24,33,35], at least 14 (40%) of whom required revascularization, 10 with coronary artery bypass grafting [23,25,28,29,31,32,37,44] and 4 with percutaneous techniques [18,34,38,43]. Thirteen cases (37%) did not have significant coronary artery disease [11,12,14,[19][20][21]26,27,30,33,39,40,53], while in the remaining 3 cases it is unclear whether coronary artery disease was present [17,36,45].…”

“…The origin of the anomalous RCA has been described as an extension of the second diagonal [34] or as a branch of the first septal perforator [16,30]. In one reported case, three discrete anomalous arteries were found to arise from the mid portion of the LAD to serve the territory of the RCA [28].…”

“…The most recent and thorough review to date by Erdogan et al references 14 cases [22]. Reasons for the discrepant number of previously reported cases may include publication bias (producing the tendency to make cases appear more unique than they truly are), incomplete literature searches [22,35,36,40,48], multiple publications of the same series [12,13,15,[49][50][51], concurrent reporting [18,22,34,40,43], and incomplete or contradictory descriptions of the anomaly leading to misidentification or misclassification [2,3,22,45]. The last point is deserving of further attention.…”

Acute myocardial infarction in a patient with anomalous origin of the right coronary artery: Depiction at whole-heart coronary magnetic resonance angiography and delayed-enhanced imaging

“…Percutaneous coronary interventions in patients with anomalous RCA are sometimes obscure because of difficulty in identifying the orifice and the course of the anomalous RCA [5]. In the present case, whole-heart coronary MRA clearly identified the location of the RCA orifice, the course and the site of occlusion.…”