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1691, "ymax": 3101 }, { "text": "21", "xmin": 1253, "ymin": 3116, "xmax": 1289, "ymax": 3145 } ], "raw_text": "Journal of Cardiovascular Neurovascular & Stroke https://mycvns.com RIGHT CORONARY ARTERY ORIGINATING FROM LEFT ANTERIOR DESCENDING ARTERY : A RARE VARIANT OF SINGLE CORONARY ARTERY DETECTED ON CT CORONARY ANGIOGRAPHY Mohd Hafizuddin Husin *1 Ahmad Aizuddin Mohamad Jamali' Mohd Azaad A Hamid' Khairulanuar Saad? Department of Radiology School of Medical Sciences Universiti Sains Malaysia Kubang Kerian Malaysia ?Diagnostic Imaging Department Hospital Raja Perempuan Zainab IT Kota Bharu Malaysia * * Corresponding author = Mohd Hafizuddin Husin P School of Medical Sciences 1 Universiti Sains Malaysia, Kubang Kerian Malaysia Email | mohafizmh@usm.my DOI : https:/doi.org/10.32896/cvns.v4n3.21-2 Received : 08.05.2022 Revised | 03.08.2022 Accepted | 04.08.2022 Published | 30.09.2022 ABSTRACT Background : A single coronary artery ( SCA ) is a rare anomaly encountered using conventional coronary angiography. Aright coronary artery (RCA ) originating from a left anterior descending artery (LAD 1 is a rare subtype of SCA Only a few cases are described in published literature Case presentation | We described this anomaly in a 55-year-old male who presented with angina pectoris. The anomalous RCA was suspected by conventional coronary angiogram and was confirmed by computed tomography ( CT ) coronary angiography Using CT we demonstrated the course of the abnormal vessel and its relation to the main vessel I We also detected the presence of plaque C which caused luminal stenosis of the proximal LAD. | which may cause global ischaemia. Conclusion | We concluded that although conventional coronary angiography is an important diagnostic method I new non-invasive methods such as CT coronary angiography can be a better screening tool to detect and characterise coronary anomalies Keywords Anomalous right coronary artery | Single coronary artery = CT coronary angiography INTRODUCTION invasive conventional coronary angiography (4 5 | ). Single coronary artery ( SCA ) is a rare anomaly We describe a case of a very rare variant of SCA in encountered only in 0.031% of the population The which an anomalous RCA arises from the mid-LAD right coronary artery (RCA ) descending originates from the left This anomaly was detected during a routine coronary anterior artery (LAD ), an extremely rare angiogram and then confirmed on computed SCA variant Only about 30 cases of the anomalies tomography ( are CT coronary angiography reported in previous literature (1-3 | Until the development of multidetector computed tomography | CASE PRESENTATION coronary artery anomalies were mainly evaluated by A54-year-old Malay ex -smoker with underlying type Electronic supplementary material This article contains supplementary materials which are available at doi htps:/doi.org/10.32896/cvns.v4n3.21-2 21 " }, { "page": 1, "image_url": 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LCX or LAD. RCA arising from the LAD is sided chest pain 1 which was aggravated by physical an extremely rare SCA variant occurring in activity Upon arrival, he was hemodynamically approximately 0.024%-0.066% of the general stable. An electrocardiogram (ECG ) revealed atrial population undergoing coronary angiography (2 ). fibrillation with a heart rate of 110 ) No acute Several authors have attempted to classify coronary ischaemic changes were present An echo showed artery anomalies. However no single classification is good left ventricular function with an ejection fraction widely accepted In a recent review , Villa et al. of 70%. A serial blood test showed raised creatine suggest a classification based on anatomical features kinase-MB CKMB ). He was treated as angina The anomalies of origin are divided into anomalies of pectoris with atrial fibrillation 1 and a coronary origin from the pulmonary artery and anomalies of angiogram was scheduled origin from the aorta. SCA falls into anomalies of Coronary angiography showed a single coronary origin from the aorta. further classified into SCA ostium with the left main coronary artery bifurcates to origin from the left sinus of Valsalva and SCA origin the LAD and the left circumflex artery (LCX) from the right sinus of Valsalva (1). The anomaly (Supplementary material 1 ). There was a mild encountered in our patient was not described in this proximal LAD disease. Multiple aortic root injections classification i The closest category that our patients confirmed the absence of a conventional RCA coronary anatomy represented was that of the LIIA originating from the anterior coronary sinus. anomaly CT coronary angiography showed a single left Coronary angiography has traditionally been the main coronary artery (LMCA ) originating from the gold standard in detecting coronary artery disease and left coronary cusp. The LMCA A demonstrates a normal coronary artery anomalies. A non -invasive method course and divides into the LAD and LCX The LAD such as CT coronary angiography produces courses inferiorly within the anterior interventricular comparable results. It has been shown that CTA groove. There is mild stenosis at the proximal aspect coronary sensitivity in visualising abnormal vessels is of the left LAD . CAD-RADS 2 with a mild plaque 100% ( (4) ). burden (P1) according to the 2022 Coronary Artery CTA coronary has multiple benefits besides non- Disease Reporting and Data System (CAD-RADS invasiveness | including providing 3D information | 2.0)(Figure 1). The anomalous RCA originates from high spatial resolution 1 and rapid examination time. It the mid-portion ofLAD This RCA courses laterally is superior in identifying the course of potentially and anteriorly to the pulmonary trunk It runs into the malignant course inter-arterial in which the right atrioventricular groove and gives rise to a coronary artery passes between the aorta and the main posterior descending artery (PDA ) distally, indicating pulmonary artery. In our case C the anomalous RCA a right dominant system (Figure 2, Supplementary has a benign course as it passes anterior to the material 2 ). pulmonary artery It also can detect other high-risk anatomic features such as slit-like ostium | proximal DISCUSSION narrowing of the vessel. intra-mural course and acute Coronary artery anomalies can be defined as a take-off angle The prevalence of coronary anomalies coronary pattern or feature encountered in less than is also higher on CTA coronary than on conventional 1% of the population (1). SCA is a rare coronary coronary angiograms (4-6 ). anomaly in which the RCA and the LMCA arise from Because of its invasiveness, radiation exposure a single aortic sinus. It was first describedin 1903, and and inability to characterise non I-coronary cardiac several cases of SCA have been reported In a recent anatomy , conventional coronary angiography in retrospective study by Turkmen et al. that included coronary artery anomalies should only be used to 215140 patients undergoing coronary angiography , complement non-invasive imaging 6 6). only 67 patients were detected to have this anomaly (0.031% ) (1, 3 ). The origin of an anomalous RCA may be from CONCLUSION the left sinus of Valsalva, posterior sinus of Valsalva, Anomalous RCA originating from the LAD is a rare CVNS 2022 V4N2 22 " }, { "page": 2, "image_url": "https://nnts.imgix.net/uploadedfiles/rawocr/481d14e6-6fd2-4b73-866e-46aabaf050de-3.jpeg?auto=compress&expires=1664524303&or=0&s=f5b7a629eeafe2b7fb766dd41097bb79", "size": { "width": 2550, "height": 3300 }, "words": [ { "text": "Journal", "xmin": 1503, "ymin": 158, "xmax": 1623, "ymax": 187 }, { "text": "of", "xmin": 1636, "ymin": 157, "xmax": 1670, "ymax": 185 }, { "text": "Cardiovascular", "xmin": 1682, "ymin": 157, "xmax": 1933, "ymax": 185 }, { "text": "Neurovascular", "xmin": 1954, "ymin": 158, "xmax": 2196, "ymax": 187 }, { "text": "&", "xmin": 2209, "ymin": 158, "xmax": 2234, "ymax": 184 }, { "text": "Stroke", "xmin": 2250, "ymin": 158, "xmax": 2354, "ymax": 187 }, { "text": "https://mycvns.com", "xmin": 2045, "ymin": 205, "xmax": 2354, "ymax": 244 }, { "text": "entity", 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originating from the mid-LAD | which was confirmed invasive coronary angiography BMC using CT coronary angiography When combined Cardiovasc. Disord 2014 Dec ;14(1):81 with other non-invasive imaging such as cardiac 6 Grani C, Buechel RR Kaufmann PA Kwong magnetic resonance imaging or nuclear and hybrid RY I Multimodality Imaging in Individuals imaging to detect high-risk physiologic consequences With Anomalous Coronary Arteries. JACC of coronary anomalies | CT coronary angiography is a Cardiovasc Imaging 2017:10(4):471-481 better choice than conventional angiography as a screening tool STATEMENT OF ETHICS Informed consent was obtained from the patients to publish the case report and the accompanying images. CONFLICT OF INTEREST The authors have no known conflict of interest to disclose FUNDING The authors received no funding from any party for this scientific work DATA AVAILABILITY STATEMENT No additional data than the one presented in this article was used REFERENCES 1 Villa AD Sammut E * Nair A, Rajani R Bonamini R Chiribiri A. Coronary artery anomalies overview The normal and the abnormal. World J Radiol. 2016 Jun | :8(6 5:537 | 2 Yurtdas M Gulen O. Anomalous origin of the right coronary artery from the left anterior descending artery review of the literature Cardiol. J | 2012 Mar;19(2):122-129 | 3. Turkmen S | Yolcu M Sertcelik A Ipek E Dokumaci B, Batyraliev T Single coronary artery incidence in 215,140 patients undergoing coronary angiography Folia Morphol. 2014 Nov;73(4):469-474 4. Erol C | Seker M Coronary Artery Anomalies The Prevalence of Origination Course and Termination Anomalies of Coronary Arteries Detected by 64-Detector Computed Tomography Coronary Angiography JCAT 2011 Sep;35(5):618-624 A 5 Ghadri JR Kazakauskaite E * Braunschweig S. Burger IA Frank M Fiechter M et al Congenital coronary anomalies detected by CVNS 2022 V4N2 23 " }, { "page": 3, "image_url": "https://nnts.imgix.net/uploadedfiles/rawocr/481d14e6-6fd2-4b73-866e-46aabaf050de-4.jpeg?auto=compress&expires=1664524303&or=0&s=399171a241afb9c88e19e9fcb24e8939", "size": { "width": 2550, "height": 3300 }, "words": [ { "text": "Journal", "xmin": 1503, "ymin": 158, "xmax": 1621, "ymax": 185 }, { "text": "of", "xmin": 1636, "ymin": 157, "xmax": 1670, "ymax": 185 }, { "text": "Cardiovascular", "xmin": 1682, "ymin": 157, "xmax": 1933, "ymax": 185 }, { "text": "Neurovascular", "xmin": 1954, "ymin": 158, "xmax": 2196, "ymax": 187 }, { "text": "&", "xmin": 2209, "ymin": 158, "xmax": 2234, "ymax": 184 }, { "text": "Stroke", "xmin": 2250, "ymin": 158, "xmax": 2354, "ymax": 187 }, { "text": "https:", "xmin": 2045, "ymin": 205, "xmax": 2129, "ymax": 241 }, { "text": "://mycvns.com", "xmin": 2126, "ymin": 205, "xmax": 2351, "ymax": 240 }, { "text": "FIGURE", "xmin": 195, "ymin": 336, "xmax": 386, "ymax": 372 }, { "text": "LEGENDS", "xmin": 403, "ymin": 336, "xmax": 638, "ymax": 372 }, { "text": "Figure", "xmin": 195, "ymin": 1942, "xmax": 335, "ymax": 1988 }, { "text": "1", "xmin": 354, "ymin": 1944, "xmax": 366, "ymax": 1972 }, { "text": "|", "xmin": 378, "ymin": 1953, "xmax": 383, "ymax": 1962 }, { "text": "Mild", "xmin": 406, "ymin": 1941, "xmax": 501, "ymax": 1978 }, { "text": "coronary", "xmin": 519, "ymin": 1953, "xmax": 692, "ymax": 1983 }, { "text": "plaque", "xmin": 710, "ymin": 1942, "xmax": 841, "ymax": 1984 }, { "text": "(P1)", "xmin": 857, "ymin": 1942, "xmax": 941, "ymax": 1980 }, { "text": "within", "xmin": 955, "ymin": 1941, "xmax": 1080, "ymax": 1977 }, { "text": "the", "xmin": 1098, "ymin": 1942, "xmax": 1158, "ymax": 1978 }, { "text": "proximal", "xmin": 1174, "ymin": 1941, "xmax": 1351, "ymax": 1984 }, { "text": "aspect", "xmin": 1369, "ymin": 1948, "xmax": 1493, "ymax": 1987 }, { "text": "of", "xmin": 1508, "ymin": 1941, "xmax": 1553, "ymax": 1978 }, { "text": "LAD", "xmin": 1562, "ymin": 1943, "xmax": 1661, "ymax": 1977 }, { "text": "with", "xmin": 1679, "ymin": 1941, "xmax": 1765, "ymax": 1978 }, { "text": "25-49%", "xmin": 1784, "ymin": 1942, "xmax": 1939, "ymax": 1977 }, { "text": "stenosis", "xmin": 1957, "ymin": 1941, "xmax": 2111, "ymax": 1977 }, { "text": "(", "xmin": 2128, "ymin": 1945, "xmax": 2137, "ymax": 1967 }, { "text": "CAD-RADS", "xmin": 2142, "ymin": 1941, "xmax": 2396, "ymax": 1978 }, { "text": "2", "xmin": 196, "ymin": 1998, "xmax": 228, "ymax": 2033 }, { "text": ").", "xmin": 216, "ymin": 1998, "xmax": 240, "ymax": 2035 }, { "text": "CVNS", "xmin": 151, "ymin": 3131, "xmax": 258, "ymax": 3158 }, { "text": "2022", "xmin": 272, "ymin": 3131, "xmax": 350, "ymax": 3158 }, { "text": "V4N2", "xmin": 366, "ymin": 3131, "xmax": 464, "ymax": 3158 }, { "text": "24", "xmin": 1265, "ymin": 3120, "xmax": 1304, "ymax": 3150 } ], "raw_text": "Journal of Cardiovascular Neurovascular & Stroke https: ://mycvns.com FIGURE LEGENDS Figure 1 | Mild coronary plaque (P1) within the proximal aspect of LAD with 25-49% stenosis ( CAD-RADS 2 ). 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