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Case Report | DOI: https://doi.org/10.31579/2641-0419/121
1Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
2Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
*Corresponding Author: Abhishek Thandra, Division of Cardiovascular Diseases Creighton University School of Medicine, 7500 Mercy Rd Suite 301, Omaha, NE, 68124
Citation: Abhishek Thandra., Raahat Bansal., Tarun Tandon., Ann Narmi., (2021) Taking over the Territory: A Case of Superdominant Right Coronary Artery. J. Clinical Cardiology and Cardiovascular Interventions, 4(4); Doi:10.31579/2641-0419/121
Copyright: © 2021 Abhishek Thandra, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 18 December 2020 | Accepted: 02 March 2021 | Published: 11 March 2021
Keywords: left circumflex artery; super-dominant; right coronary artery
Coronary artery anomalies are a diverse group of congenital disorders, with a reported incidence of 0.6 – 1.3%. Congenital absence of the LCX is an extremely rare anomaly, with a frequency of only 0.003% in all patients who undergo coronary angiography. Here, we present a case of 76-year-old female who had an episode of chest pain while she was hospitalized for management of small bowel obstruction with elevated troponin and coronary angiogram showed super-dominant right coronary artery without any obstructive disease.
Running Title: Congenital absence of left circumflex artery
LCX=left circumflex artery
RCA=right coronary artery
A 76-year-old femalse with history of hypertension, diabetes mellitus type 2, and hyperlipidemia was admitted with a diagnosis of small bowel obstruction and managed conservatively. During her hospitalization, she complained of chest pressure. Initial evaluation included a physical examination and electrocardiogram, which were unremarkable. Troponin I peaked at 3.94 ng/ml (≤0.04 ng/ml). Her Echocardiogram demonstrated apical segment akinesis with an ejection fraction of 30%. Coronary angiogram showed no angiographic evidence of coronary artery disease. However, the left circumflex artery (LCX) artery did not originate from the left main coronary artery. Rather, the super-dominant right coronary artery (RCA) had a large postero-lateral branch, which occupied the atrio-ventricular groove and supplied the lateral wall of the myocardium (Figure 1, Figure 2a, 2b and 2c).
Coronary artery anomalies are a diverse group of congenital disorders, with a reported incidence of 0.6 – 1.3%. [1] Congenital absence of the LCX is an extremely rare anomaly, with a frequency of only 0.003% in all patients who undergo coronary angiography [1]. With absence of LCX, the lateral wall of the left ventricle is mostly supplied by a super-dominant RCA (90% of the time) or occasionally by a multiple diagonal branch of LAD [2,3]. On literature review, super-dominant RCA is always associated with an absent LCX. Considered to be a benign anomaly, a few cases have reported its association with systolic click syndrome, ischemic changes in the zone of hypoperfusion, heart failure, and syncope [3,4]. Coronary angiogram or coronary CTA are used for definitive diagnosis.
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