Anomalous left main coronary artery originating from the right coronary cusp: A case series and clinical implications

Cardiovascular Revascularization Medicine: Interesting Cases Pub Date : 2025-06-12 DOI:10.1016/j.crmic.2025.100084

Ghulam Mujtaba Ghumman , Adel Kanaan , Sanam Farooq , Abdul Baqi , F.N.U. Salman , Moaaz Baghal , Syed Sohail Ali

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Abstract

Background

Anomalous origin of the left main coronary artery (LMCA) from the right coronary cusp is a rare congenital anomaly with diverse clinical presentations and significant implications for patient management.

Case summary

This case series presents three unique cases of anomalous LMCA origin from the right coronary cusp, each with distinct clinical manifestations and management strategies. Case 1 involved an 82-year-old male presenting with heart failure symptoms, where coronary angiography revealed an anomalous LMCA with a retro-aortic course (benign), managed conservatively. Case 2 describes a 71-year-old female presenting with non-ST-segment elevation myocardial infarction (NSTEMI) due to a culprit right coronary artery (RCA) lesion, with the LMCA taking a pre-pulmonic course (benign), successfully treated with percutaneous coronary intervention (PCI) of the RCA. Case 3 details a 76-year-old male evaluated for exertional fatigue and abnormal stress test, found to have an anomalous LMCA with a malignant interarterial course, for which surgical revascularization was recommended, though the patient opted for conservative management.

Discussion

The series underscores the importance of recognizing LMCA anomalies and tailoring management strategies based on anatomical course and clinical presentation. Coronary computed tomography angiography (CTA) plays a pivotal role in delineating coronary anatomy and guiding management. Benign courses are managed conservatively, while malignant interarterial courses necessitate surgical consideration due to the increased risk of sudden cardiac death.

Conclusion

Anomalous origin of the LMCA from the right coronary cusp presents diagnostic and therapeutic challenges, requiring a multidisciplinary approach for optimal management. Early identification and accurate characterization of the coronary course are critical for guiding intervention and improving outcomes.

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起源于右冠状动脉尖的左冠状动脉主干异常：一个病例系列和临床意义

背景：左主干冠状动脉（LMCA）起源于右冠状动脉尖是一种罕见的先天性异常，临床表现多样，对患者治疗有重要意义。本病例系列报告了三个独特的起源于右冠状动脉尖的LMCA异常病例，每个病例都有不同的临床表现和治疗策略。病例1为一82岁男性，表现为心力衰竭症状，冠状动脉造影显示LMCA异常伴主动脉后病变（良性），保守治疗。病例2描述了一名71岁女性，由于右冠状动脉（RCA）病变导致非st段抬高型心肌梗死（NSTEMI）， LMCA采取肺前病程（良性），经RCA经皮冠状动脉介入治疗（PCI）成功治疗。病例3详细描述了一名76岁男性，因劳累疲劳和异常压力测试而接受评估，发现LMCA异常伴恶性动脉间程，建议手术重建术，但患者选择保守治疗。该系列强调了识别LMCA异常和根据解剖过程和临床表现定制管理策略的重要性。冠状动脉ct血管造影（CTA）在描绘冠状动脉解剖结构和指导治疗方面起着关键作用。良性病程保守处理，而恶性动脉间病程由于心源性猝死的风险增加，需要手术治疗。结论右冠状动脉尖部LMCA异常起源给诊断和治疗带来挑战，需要多学科联合治疗。早期识别和准确描述冠状动脉病程对指导干预和改善预后至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Cardiovascular Revascularization Medicine: Interesting Cases

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