Unidirectional communication between the circumflex and right coronary arteries: a very rare coronary anomaly and cause of ischemia

Abstract

Intercoronary communication is an exceptionally rare congenital malformation. A 43-year-old male was admitted to our cardiology department with symptomatic stable angina. ECG and echocardiography was normal. Exercise electrocardiography showed ST depression in inferior leads. No atherosclerotic plaque in the coronary arteries was detected on coronary angiography. However, a unidirectional intercoronary communication between the circumflex and right coronary arteries, which was leading a coronary steal from right to left, was observed. Although intercoronary communication is generally not related with ischemia, ischemic symptoms and exercise ECG changes of this case suggested that unidirectional flow might cause myocardial ischemia via coronary steal. Consequently, intercoronary communication, a very rare coronary anomaly and a cause of ischemia, is discussed in this case report.

Koroner Ark: Nadir bir koruyucu koroner arter anomalisi

“…Coronary circulation's anomalies and variants are classified into four main groups; anomalies of origin, distribution, course and termination (1,4). Intercoronary communication or coronary arcade is a very rare coronary artery termination anomaly with unidirectional or bidirectional blood flow between two coronary arteries and is seen during coronary angiography in patients with or without coronary artery stenosis (5,6). The true Figure 1.…”

A Rare Coronary Anomaly; Coronary Continuity: Case Report

“…Unidirectional or bidirectional flow patterns have been reported in different cases, and some of those claimed that this anomaly could cause ischemia. 2 The theory that unidirectional flow and coronary ischemia are due to coronary steal can be incorrect regarding coronary continuity. The left coronary artery diameter is wider than the RCA, and when injecting a contrast agent, applied pressure at the distal part of the RCA is usually higher than the distal part of the CX.…”

Arcada coronária – uma anomalia rara da circulação coronária

“…Na literatura, estão descritos dois tipos: um localizado no sulco auriculoventricular posterior entre a coronária direita e a circunflexa e outro no sulco interventricular, entre a descendente anterior e a descendente posterior 9 .…”