Successful Surgery of a Combined Anomalous Origin Right Coronary Artery-Left Circumflex Artery Case with Symptoms due Its Interarterial Course and Compression

Abstract

We report a case of chest pain due to a combined anomalous origin right coronary artery-left circumflex artery and its surgical treatment. A patient with chest pain on exertion was admitted to our cardiology clinic. His electrocardiogram showed evidence of ischaemia (D2, D3, AVF ST depression and T negativity). Echocardiography findings and cardiac enzyme levels were normal. These findings led to the diagnosis of stable angina pectoris, and cardiac catheterisation was performed. During catheterisation, it was not possible to enter in the right coronary artery ostium, and coronary computed tomography angiography was performed. Scans showed that the right coronary artery was originating from the left coronary cusp, continued its course between the pulmonary artery and ascending aorta and followed the course of a normal right coronary artery. The right coronary artery was non-dominant, and due to compression, its calliper was thinner at the interarterial level. The left circumflex coronary artery originated as a branch from the middle segment of the right coronary artery, continued the course of a normal left circumflex artery and was dominant. In line of these findings, we decided that the symptoms occurred because of compression at the interarterial level. Because of high compression, percutaneous transluminal coronary angioplasty and stenting were ruled out, and the patient was prepared for surgery. Single coronary artery bypass on the beating heart with the use of the right internal mammary artery was performed. The distal end of the graft was anastomosed to the middle segment of the right coronary artery to the area before that where the left circumflex artery originated as a branch. Sudden cardiac death can be seen after exertion in cases of coronary artery anomalies with an interarterial course. Therefore, young patients with chest pain should be considered and evaluated with the possibility of coronary artery anomaly. Coronary computed tomography angiography is very helpful in the diagnosis of this anomaly. Therefore, these patients can be treated with simple invasive interventions or surgeries and can lead a normal life.