Anomalous origin of the circumflex artery with retro-aortic course

Case contributed by Dr Kamel Mahmoud Alkhateeb

Presentation

Angina pectoris

Patient Data

Age: 50 years
Gender: Male

Anomalous origin and course of left circumflex artery (LCx) (type III): LCx originates from proximal right coronary RCA (just next to RCA origin from right coronary sinus). LCx has a retro-aortic course, passing between the aorta and left atrium. It is non-dominant and patent with no evidence of plaque or stenosis.

Case Discussion

An anomalous origin of the left circumflex artery from the right coronary sinus is the most common congenital variant and is divided into three types:

  • Type I: Separate ostia for right coronary artery (RCA) and LCX.

  • Type II: Common ostia in the right sinus.

  • Type III: LCX arising as a branch of the proximal RCA.

These patients may develop coronary symptoms due to kinking/compression of a retroaortic course.

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