{"title":"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","authors":"Ghulam Mujtaba Ghumman , Adel Kanaan , Sanam Farooq , Abdul Baqi , F.N.U. Salman , Moaaz Baghal , Syed Sohail Ali","doi":"10.1016/j.crmic.2025.100084","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Case summary</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100084"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anomalous left main coronary artery originating from the right coronary cusp: A case series and clinical implications\",\"authors\":\"Ghulam Mujtaba Ghumman , Adel Kanaan , Sanam Farooq , Abdul Baqi , F.N.U. Salman , Moaaz Baghal , Syed Sohail Ali\",\"doi\":\"10.1016/j.crmic.2025.100084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Case summary</h3><div>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.</div></div><div><h3>Discussion</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":100217,\"journal\":{\"name\":\"Cardiovascular Revascularization Medicine: Interesting Cases\",\"volume\":\"8 \",\"pages\":\"Article 100084\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Revascularization Medicine: Interesting Cases\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2950275625000309\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Revascularization Medicine: Interesting Cases","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2950275625000309","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Anomalous left main coronary artery originating from the right coronary cusp: A case series and clinical implications
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.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
