Presentation
Non-specific chest pain and easy fatigability.
Patient Data
The observed calcium score is 75.4
There is note of an aberrant origin of the left coronary artery from the right aortic sinus, taking an anomalous course anterior to the pulmonary trunk.
A CT coronary angiogram was recommended for further evaluation.
The left main coronary artery (LCA) arises from the right coronary sinus (with a separate ostium) and is seen coursing superiorly, crossing in front of the main pulmonary artery (MPA) and reaching the proximal anterior interventricular groove, where it gives off the left anterior descending artery (LAD) and left circumflex artery (LCX).
The left main artery is widely patent.
The proximal LAD has a calcified plaque causing less than 50% stenosis. The mid and distal LAD are patent. The LAD reaches the cardiac apex (type II vessel). The first and third diagonal arteries (D1 and D3) are diminutive. The D2 is small and patent.
LCX is diminutive.
The right coronary artery (RCA) is a moderate-sized vessel that arises from the right coronary sinus. The proximal, mid, and distal RCA are patent. The posterior descending artery (PDA) is patent, as it reaches the cardiac apex. The posterolateral artery (PLA) is patent, as it reaches the lateral cardiac apex.
Case Discussion
Anomalous aortic origins of a coronary artery are rare, with anomalies of the left even more infrequent than those of the right. A left coronary artery (LCA) that arises from the right coronary sinus is further classified based on its course. A prepulmonic course is considered benign. Other variants are:
interarterial (between the aorta and the pulmonary artery)
retroaortic coronary course
-
septal (subpulmonic)
Case submitted by Neil Eric L. Pecache, MD, Adriel Laurenz B. Tan, MD, Simonette T. Sawit, MD, and Jaime S. Samaniego, MD.
Unable to process the form. Check for errors and try again.