Double coronary anomaly: A case report

Abstract

We describe an extremely rare case of a 37-year-old female patient who presented with exertional angina and was diagnosed with a unique coronary anomaly with an anomalous right coronary artery with origin in the left anterior descending artery and a fistula between this anomalous coronary artery and the pulmonary artery.

Learning objectives: Most patients with coronary anomalies are asymptomatic but some may have angina caused by a coronary steal phenomenon, myocardial infarction, or even sudden death depending on the circuit and characteristics of the anomaly.The combination of multiple coronary anomalies is extremely rare.Despite being a rare diagnosis, coronary anomalies should always be considered as a cause of myocardial ischemia, especially in young patients with low probability for coronary obstructive disease.

Keywords: ARCA, anomalous origin of the right coronary artery; Anomalous origin of the right coronary artery; CTA, computed tomography angiography; Chest pain; Congenital heart defect; Coronary fistula; Coronary vessel anomaly; Cx, circumflex artery; Double coronary anomaly; ECG, electrocardiogram; ICA, invasive coronary angiography; LAD, left anterior descending coronary artery; LM, left main coronary artery; PA, pulmonary artery; PDA, posterior descending artery; RCA, right coronary artery; RI, ramus intermedius.

Fig. 1

(A–D). Computed tomography coronary angiography showing a fistula to the pulmonary artery with origin in the left descending artery. Cx, circumflex artery; LAD, left anterior descending artery; LM, left main coronary artery; PA, pulmonary artery; PDA, posterior descending artery; RI, ramus intermedius.

Fig. 2

(A) Computed tomography coronary angiography showing the surgical ligation site of the fistula. (B) Coronary angiography in the right anterior oblique caudal view after excision of the fistula. Yellow arrow and yellow box: incision site. LAD, left anterior descending artery; PA, pulmonary artery.