Interarterial course of the left coronary artery
Updates to Case Attributes
This patient is experiencing chest pain, without ST elevation and had undergone catheter coronary angiography. The left system was challenging to cannulate due to an anomalous origin (fromfrom the right coronary cusp)sinus. Therefore, a request was made for CT coronary angiography was performed to detectimage the anomalous origin of LMCA & LCX lesions.
The right coronary artery and left main artery both originate from the right coronary sinus with separate adjacent openings and therefore the patient has been diagnosed with, i.e. an anomalous left coronary artery origin from the right coronary sinus. The left main coronary artery has an interarterial course of the left coronary artery (betweenbetween the RVOT/main pulmonary artery and the aorta), which is considered malignant and requires further medical attention. This can be associated with sudden death or be a benign incidental finding 3.
Case courtesy of Dr Safwat Almoghazi, MD, radiologist, Dr Shreeram Kannan Consultant Radiologist Dr Ahmed Nabil Consultant Cardiologist.
-<p>This patient is experiencing chest pain, without ST elevation and had undergone catheter coronary angiography. The left system was challenging to cannulate due to an anomalous origin (from the right coronary cusp). Therefore, a request was made for <a href="/articles/cardiac-ct-1" title="CT coronary angiography">CT coronary angiography</a> to detect the <a href="/articles/anomalous-aortic-origin-of-coronary-artery" title="Anomalous origin of the coronary artery arising from the opposite sinus (ACAOS)">anomalous origin of LMCA</a> & LCX lesions.</p><p> The right coronary artery and left main artery both originate from the right coronary sinus with separate adjacent openings and therefore the patient has been diagnosed with an <a href="/articles/anomalous-aortic-origin-of-coronary-artery" title="Anomalous aortic origin of coronary artery">anomalous</a> left coronary artery from the right coronary sinus. The left main artery has an <a href="/articles/interarterial-course-of-the-left-coronary-artery-1" title="Interarterial course of the left coronary artery">interarterial course of the left coronary artery</a> (between the RVOT/main pulmonary artery and the aorta), which is considered malignant and requires further medical attention.</p><p><em>Case courtesy of Dr Safwat Almoghazi, MD, radiologist, Dr Shreeram Kannan Consultant Radiologist Dr Ahmed Nabil Consultant Cardiologist.</em></p>- +<p>This patient is experiencing chest pain without ST elevation and had undergone catheter coronary angiography. The left system was challenging to cannulate due to an anomalous origin from the right coronary sinus. <a href="/articles/cardiac-ct-1" title="CT coronary angiography">CT coronary angiography</a> was performed to image the <a href="/articles/anomalous-aortic-origin-of-coronary-artery" title="Anomalous origin of the coronary artery arising from the opposite sinus (ACAOS)">anomalous origin of LMCA</a> & LCX lesions.</p><p>The right coronary artery and left main artery both originate from the right coronary sinus with separate adjacent openings, i.e. an anomalous left coronary artery origin from the right coronary sinus. The left main coronary artery has an <a href="/articles/interarterial-course-of-the-left-coronary-artery-1" title="Interarterial course of the left coronary artery">interarterial course </a>between the RVOT/main pulmonary artery and the aorta. This can be associated with sudden death or be a benign incidental finding <sup>3</sup>.</p><p><em>Case courtesy of Dr Safwat Almoghazi, MD, radiologist, Dr Shreeram Kannan Consultant Radiologist Dr Ahmed Nabil Consultant Cardiologist.</em></p>
References changed:
- 3. Bigler M, Kadner A, Räber L et al. Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing. JAHA. 2022;11(20):e027098. <a href="https://doi.org/10.1161/jaha.122.027098">doi:10.1161/jaha.122.027098</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/36205254">Pubmed</a>
- 1. Neves P, Andrade J, Monção H. Coronary Anomalies: What the Radiologist Should Know. Radiol Bras. 2015;48(4):233-41. <a href="https://doi.org/10.1590/0100-3984.2014.0004">doi:10.1590/0100-3984.2014.0004</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26379322">Pubmed</a>
- 1. Neves P, Andrade J, Monção H. Coronary Anomalies: What the Radiologist Should Know. Radiol Bras. 2015;48(4):233-41. <a href="https://doi.org/10.1590/0100-3984.2014.0004">doi:10.1590/0100-3984.2014.0004</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26379322">Pubmed</a>
- 2. Villa A, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary Artery Anomalies Overview: The Normal and the Abnormal. World J Radiol. 2016;8(6):537-55. <a href="https://doi.org/10.4329/wjr.v8.i6.537">doi:10.4329/wjr.v8.i6.537</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27358682">Pubmed</a>
- 1. Neves P, Andrade J, Monção H. Coronary Anomalies: What the Radiologist Should Know. Radiol Bras. 2015;48(4):233-41. <a href="https://doi.org/10.1590/0100-3984.2014.0004">doi:10.1590/0100-3984.2014.0004</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26379322">Pubmed</a>
- 1.
- 2. Villa A, Sammut E, Nair A, Rajani R, Bonamini R, Chiribiri A. Coronary Artery Anomalies Overview: The Normal and the Abnormal. WJR. 2016;8(6):537. <a href="https://doi.org/10.4329/wjr.v8.i6.537">doi:10.4329/wjr.v8.i6.537</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27358682">Pubmed</a>
Updates to Study Attributes
Left coronary system:
The left main coronary artery originates from the right anterior sinus with a course between the RVOT/main pulmonary artery and the aorta. The left main coronary artery is long and of medium diameter. The left anterior descending artery originates from the left main. This artery is medium in size and mildly calcified. This artery has one diagonal. The proximal left anterior descending coronary artery has a non-flow-limiting (<50%) stenosis. The mid-left anterior descending coronary artery has a non-flow-limiting (<50%) stenosis. The circumflex coronary artery originates from the left main coronary artery. This artery is medium in size and without calcification. This artery has three major obtuse marginals. The circumflex coronary artery is free of stenosis in its proximal, and distal segments.
Right coronary system:
The right coronary artery originates from the right anterior sinus. This artery is medium in size and without calcification. The proximal right coronary artery has severe (70-90%) stenosis. The distal right coronary artery has a non-flow-limiting (<50%) stenosis.
Opinion:
Right dominant system with anomalous origin of left main from the right coronary sinus, with a malignant course between the right ventricular outflow tract (RVOT)/main pulmonary artery and aorta, severe stenosis of proximal RCA, non-obstructive disease of LAD, CAD RADS 4a/P2/E.
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