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Case Reports
. 2020 Feb;11(2):41-43.
doi: 10.14740/jmc3429. Epub 2020 Feb 28.

Percutaneous Coronary Intervention in an Octogenarian With Anomalous Origin Arising From Right Sinus: A Rare Case Report

Yeriswamy Mogalahally Channabasappa  1 , Natraj Setty Hulliurudurga Srinivasa Setty  1 , Sandeep Shankar  1 , Ravindranath Kandenahalli Shankrappa  1 , Jayashree Kharge  1 , Raghu Tagatagere Ramegowda  1 , Rahul Patil  1 , Sathish Kerur  1 , Manjunath Cholenahally Nanjappa  1
Affiliations
Case Reports

Percutaneous Coronary Intervention in an Octogenarian With Anomalous Origin Arising From Right Sinus: A Rare Case Report

Yeriswamy Mogalahally Channabasappa et al. J Med Cases. 2020 Feb.

Abstract

Anomalous coronary artery origins are not common in routine clinical practice. The incidence of coronary anomalies in patients undergoing coronary angiography is less than 1%. The greatest challenges faced in the management are delays in identification and difficulty engaging the anomalous coronary artery. Operator experience in promptly identifying the anomaly and selection of the appropriate catheter is critical for successful intervention. We are presenting a case of acute inferior and posterior wall myocardial infarction (MI) with an anomalous origin of the left circumflex artery from the right coronary sinus. Learning objective is that percutaneous coronary intervention (PCI) in an anomalous left circumflex can be technically difficult because selective cannulation of the vessel may not be easy. An anomalous left circumflex artery has a rare presentation of ST-elevation myocardial infarction (STEMI). Complicated STEMI with cardiogenic shock is not commonly seen in anomalous coronary artery origin from the right sinus. Percutaneous intervention in patients with STEMI with an anomalous left circumflex artery has a high risk and is technically challenging.

Keywords: Anomalous coronary artery; Left circumflex; Percutaneous coronary intervention.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
(a) Electrocardiogram showing normal sinus rhythm with first degree AV block, ST-segment elevation in II, III, and aVF; (b) Electrocardiogram showing ST-segment elevation in posterior leads V7 - V9; (c) Electrocardiogram showing recurrent monomorphic VT. AV: atrioventricular; VT: ventricular tachycardia.
Figure 2
Figure 2
(a) Left coronary angiography showing normal LMCA and LAD; (b) right coronary angiography showing anamalous LCX from right sinus with total occlusion and non-dominant RCA; (c) right coronary angiography showing 3.5 × 24 mm DES deployed at 11 atm; (d) right coronary angiography showing dominant LCX with TIMI III flow (LAO and RAO views). LMCA: left main coronary artery; LAD: left anterior descending artery; LCX: left circumflex artery; DES: drug-eluting stent; LAO: left anterior oblique; RAO: right anterior oblique.
See this image and copyright information in PMC

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