Clinical SpotlightAnomalous Origin of Posterior Descending Artery from Left Anterior Descending in the Presence of a Diminutive Right Coronary Artery: Diagnosed by ECG Gated Multi-detector CT
Introduction
Coronary artery anomalies have an incidence of 0.2–1.2% in general population and are usually discovered incidentally [1]. Anomalous origin of the PDA as from the left anterior descending artery (LAD) is a very rare anomaly [2], [3], [4], [5], [6]. Herein we report a case of posterior descending artery as a continuation of LAD in the presence of a diminutive but normal originating right coronary artery (RCA) discovered during a coronary CT angiogram.
Section snippets
Case Presentation
A 50 year-old woman presented to our centre to undergo coronary CT angiography for evaluation of chest pain. Her past medical history was insignificant except for hyperlipidaemia. Retrospectively gated cardiac CT was performed on a 64-slice scanner (Somatom Sensation 64; Siemens Medical Solutions, Erlangen, Germany). It was observed that the left main coronary artery was normal sized and gave off the LAD and the left circumflex (LCx) arteries. LCx was a normal and non-dominant artery which
Discussion
Coronary artery anomalies have an incidence of 0.2–1.2% in general population [1] and some of them are haemodynamically significant and are associated with adverse outcome. Coronary CT angiography is gaining a major role in the diagnosis of the coronary artery disease and is considered as a first line in the detection and evaluation of the coronary anomalies [7].
Several unusual variations in the origin of PDA have been reported such as dual PDA, early origin of the PDA from the RCA, perfusion
References (7)
- et al.
Left coronary dominance due to direct continuation of the left anterior descending to form the posterior descending coronary artery
Chest
(1992) - et al.
Anomalous origins of the right and posterior descending coronary arteries from the left anterior descending coronary artery: unusual pattern of single coronary artery
J Cardiol Cases
(2011) - et al.
Left anterior descending artery arising as a terminal extension of posterior descending artery (a rare coronary artery anomaly)
Interact Cardiovasc Thorac Surg
(2003)
Cited by (3)
Hyper-dominant left anterior descending coronary artery with continuation as a posterior descending artery—An extended empire
2018, Journal of the Saudi Heart AssociationCitation Excerpt :It either reaches up to the crux or crosses beyond it and may or may not run into the anterior atrio-ventricular groove, partially parallel to the native RCA [8]. Terminally, it may supply the left atrium or left ventricle or may divide into the RCA branches [3,9]. The clinical suspicion should arise in cases with severe hemodynamic compromise in the presence of minor ECG changes, absence of signs of prior (old) myocardial infarction but poor left ventricular function involving anterior and inferior walls.
Is it a Descending or an Ascending Artery?
2011, Heart Lung and Circulation