A 45-year-old gentleman, with no coronary risk factors had a mildly positive exercise stress test. Clinical examination ECG and chest X-ray were normal. Coronary angiogram showed ectatic left anterior descending (Fig. 1A, Video 1) and right coronary artery (Fig. 1B, Video 2) collateralizing the left circumflex artery which was seen to drain into main pulmonary artery. A coronary CT angiogram showed an anomalous origin of left circumflex artery from the right pulmonary artery (Fig. 1C and D).
Fig. 1.
Anomalous origin of left circumflex artery from pulmonary artery. (A) Left coronary angiogram (RAO projection) showing LCX (arrow) filling through collaterals from LAD and draining into MPA. (B) Right coronary angiogram (AP projection) showing LCX (arrow) filling through collaterals from RCA and draining into MPA. (C) CT angiogram showing anomalous origin of LCX from RPA. (D) CT reconstruction showing anomalous origin of LCX from RPA. RAO – Right Anterior Oblique; LCX – Left Circumflex; RCA – Right Coronary Artery; AP – Antero Posterior; RPA – Right Pulmonary Artery; MPA – Main Pulmonary Artery.
Supplementary video related to this article can be found at http://dx.doi.org/10.1016/j.ihj.2013.12.027
The following are the supplementary data related to this article:
Left coronary injection shows dilated left anterior descending artery giving collaterals to left circumflex artery which drains into MPA.
Right coronary injection shows a hugely dilated right coronary artery which giving collaterals to left circumflex artery which drains into MPA.
Anomalous LCX arising from PA is rare and incidentally detected.1,2
Conflicts of interest
All authors have none to declare.
References
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Associated Data
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Supplementary Materials
Left coronary injection shows dilated left anterior descending artery giving collaterals to left circumflex artery which drains into MPA.
Right coronary injection shows a hugely dilated right coronary artery which giving collaterals to left circumflex artery which drains into MPA.