|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 120-121
A Rare Case of Origin of Left Main Coronary Artery Arising from Rt Aortic Sinus
Alok Kumar Singh1, Rishi Sethi2
1 Department of Cardiology, Heritage Hospital, Varanasi, Uttar Pradesh, India
2 Department Cardiology, C S M Medical University, Lucknow, Uttar Pradesh, India
|Date of Web Publication||21-Dec-2015|
Alok Kumar Singh
Department of Cardiology, Heritage Hospital, Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh AK, Sethi R. A Rare Case of Origin of Left Main Coronary Artery Arising from Rt Aortic Sinus. Heart India 2015;3:120-1
A 63-year-old male presented with the history of effort angina class II for last 8 months. He was known diabetic for last 5 years on regular treatment. There was no history of rest chest pain, hypertension. His past and family histories were unremarkable. He had no anemia, cyanosis, jaundice, clubbing, and lymphadenopathy. All peripheral pulses were normal and palpable. Blood pressure and respiration were normal. Other systemic examinations were normal. His electrocardiogram shows right bundle branch block and ST-segment depression of 1 mm in lateral and inferior leads. Complete blood count, including erythrocyte sedimentation rate, lipid profile, chest X-ray, and echocardiography were normal. Coronary angiography shows right dominant circulation and left main coronary artery (LMCA) arising from Rt aortic sinus, passes posteriorly around the aortic root (retroaortic course) and giving rise left anterior descending (LAD) artery and left circumflex (LCx) artery [Figure 1] and [Figure 2]. The LAD coronary artery showing 70% type B eccentric lesion with distal thrombolysis in myocardial infarction III flow.
|Figure 1: Lao caudal view showing left main coronary artery arising from ritght aortic sinus|
Click here to view
|Figure 2: Rao 45 view showing retroaortic course of left main coronary artery|
Click here to view
Congenital coronary anomalies are infrequent (<1%) findings on coronary arteriography, but may be associated with myocardial ischemia in certain settings.  The most common anomaly is a separate origin of the LAD and LCx coronary arteries, followed by the origin of the LCx from the right coronary sinus and origin of the right coronary artery (RCA) from the left coronary sinus. The incidence of origin of LMCA from Rt aortic sinus is 0.02% among the all coronary angiogram and 1.3% among the coronary anomalies.  In a series from Harikrisnan et al.  only one patient out of 7400 has LMCA and RCA from right aortic sinus.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21:28-40.
Harikrisnan S, Jacob SP, Tharakan J, Titus T, Ajith Kumar VK, Bhat A, et al.
Congenital coronary anomalies of origin and distribution in adults: A coronary arteriographic study. Indian Heart J 2002;54:271-5.
[Figure 1], [Figure 2]