Unusual coronary anatomy in an adult with CAD:

Anomalous left circumflex coronary artery originating from the right sinus of Valsalva

Splittgerber FH

In adults congenital coronary anomalies are observed with a frequency of about 0.8%. The left circumflex coronary artery originating from the right sinus takes up more than half of all the anomalies seen.

There is nearly no pathognomonic significance: different from the LCA, LAD or RCA originating from the opposite sinus there is no danger of sudden ischemia from narrowing of the already slitlike ostium with exercise or from compression between the aorta and pulmonary artery. It appears that the anomalous course does not lead to an increased rate of atherosclerotic changes in the vesssel. The lesion does have some significance to the cardiac surgeon, since it can be easily damaged during mitral valve replacement.

This is is selective injection into the abnormally originating vessel:

The anomaly can be recognized by two radiographic signs:

• the "aortic root sign":

 

 
 
 



this is seen in the RAO projection with contrast agent filling the aortic root. There appears to be a small "dot" inferior/posterior to the aortic root. This dot is the anomalously coursing vessel.

• the "sign of nonperfused myocardium":

 

 
 
 



when injecting contrast into the LCA there appear to be nearly no vessels (this is somewhat variable) in the area that is usually supplied by a normally originating left circumflex coronary artery.

1. Page HL et al. Anomalous origin of the left circumflex coronary artery. Circulation 1974; 50:768-73
2. Wilkins CE et al. Coronary artery anomalies. Texas H Inst J 1988; 15:166-73
3. Serota H et al. Rapid identification of the course of anomalous coronary arteries in adults: the "dot and eye" method. Am J Cardiol 1990; 65:891-8
4. Cheng TO. Surgical deangulation of an anomalous origin of right coronary artery [letter]. Ann Thorac Surg 1995; 59:1043-4

Copyright Fred Splittgerber.

BACK TO CASES

last update Sept 21, 1999