INTRODUCTION

About 0.6 to 1.55% of patients who undergo coronary angiography have coronary artery abnormalities (1, 2). Dificulties may occur in the diagnostic procedure but recognition and adequate visualization of the anomaly is essential for proper patient management especially in patients undergoing evaluation for percutaneous coronary intervention (3). We present a case of an aberrant origin of the circum€ex coronary artery (Cx) from the proximal right coronary artery (RCA) diagnosed in percutaneous coronary intervention (PCI) in a patient who had an inferior myocardial infarction.

CASE REPORT 

A 65-year-old male patient presented to the Emergency Department (ED) one hour after experiencing a typical acute angina chest pain. He had a 50 packs-year history of cigarette smoking, with a history of hypertension and diabetes mellitus. His vital signs were as follows : blood pressure 130/70 mmHg, pulse rate 72 beats/min, respiratory rate 20 breaths/min and oxygen saturation with pulse oximetry 98%. An electrocardiogram showed an ST-depression from leads V1 to V6. Troponin assay performed at six hours from the onset of chest pain was positive at 1.69 μg/l (normal: < 0.05 μg/l :). A dual anti-platelet and anti-thrombosis medication was given. A PCI showed a narrow stenosis of the circum€ex artery (Cx) arising directly from the right coronary artery (Figure 1). A stent was performed in the proximal Cx swelling with a TIMI III €ow rate. The evolution was favorable without complications.

DISCUSSION 

Anatomical variations of the coronary arteries have been found in 0.64 to 1.55% of patients submitted to a coronary angiography. These authors also a!rm that the circum€ex branch originating in the right coronary artery is the most common anatomical variations of the coronary artery (1, 2). The rst case series of PCI performed on such aberrant vessels was described in 1982 (4). Samarendra et al. (5) a!rmed that the circum€ex branch of the coronary artery originating in the right side, is the most common “benign” coronary anomaly and is not considered the cause of ischemia or myocardial infarction, which conrms the conclusions of Click et al. (6) when they claim that the most common anomaly involving the coronary artery is the one of the circum€ex branch, although such anomalies are not common in adults. It must be considered however, that this condition can be present at birth, being little symptomatic during childhood, and being found incidentally through the coronary arteriography or necropsy. In this present report, the diagnosis of this aberrant coronary artery was made after undergoing a percutaneous coronary intervention for myocardial infarction.

Although it was not our goal in this work, we believe that the assumption made by some authors that the circum€ex branch originating in the right coronary artery must be considered as an anatomical variation and not an anomaly, must be studied more deeply to be validated.

CONCLUSION

The coronary artery anomaly origins may cause myocardial ischemia and sudden death. Coronary angiography is the key in the diagnosis of these abnormalities. Dificulties may occur in the diagnostic procedure but recognition and adequate visualization of the anomaly is essential for proper patient management especially in patient undergoing evaluation for percutaneous coronary intervention.