Anomalous Left Circumflex Coronary Artery Arising from the Right Pulmonary Artery
We report a case of anomalous origin of the left circumflex coronary artery (LCX) arising from the right pulmonary artery (RPA) resulting in stress-induced cardiac arrest. The previously healthy 30 year old female patient collapsed after running a 5K race and was successfully resuscitated. Subsequent coronary CT angiography (CCTA) revealed the culprit anatomy, which was successfully treated with surgical ligation. To the authors’ knowledge, this is the only the second case of this variant coronary anomaly resulting in aborted sudden cardiac death, subsequent surgical ligation, and recovery in a healthy young adult and is the first case treated by ligation alone without coronary bypass. Figure legends: Fig. 1. Coronal 3D volume-rendered image of the coronary tree demonstrating anomalous connection of the LCX to the right pulmonary artery (skinny white arrow) coursing posterior to the proximal LMCA (white arrowhead). The native RCA (fat white arrow) originates from the right sinus of valsalva as expected. Fig. 2. Late diastolic angiographic image demonstrates retrograde filling of the LCX (black arrowhead) from a network of coronary-coronary collateral vessels (black arrows). Contrast is seen spilling into the right pulmonary artery (white arrowhead). Fig. 3. Early diastolic angiographic image demonstrates massively dilated native LAD (black arrowhead), RCA (white arrowhead) and a network of coronary-coronary collaterals (skinny black arrows). Faint retrograde filling is seen of the LCX (fat black arrow).