[1-3] The most common congenital anomaly is separate origin of the left anterior descending artery and
circumflex artery from the left coronary sinus.
Yip HK1, Wu CJ, Fu M, Yeh KH, Yu TH, Hung WC etal Clinical features and outcome of patients with direct percutaneous coronary intervention for acute myocardial infarction resulting from left
circumflex artery occlusion.
Caption: Figure 1: Angiography after the compensation of heart failure reveals severe stenosis with heavy calcification of the left anterior descending artery, chronic total occlusion of the left
circumflex artery (a), and hypoplasty of the right coronary artery (b).
Congenitally absent left
circumflex artery is an extremely rare anomaly of coronary arteries with only a small number of cases having been reported, but its incidence is increasing due to the wide use of MDCT Coronary angiography.
Out of total of 63(30%) unsuccessful PCI's LAD comprised of 28(44.7%), RCA 22(34.9%),
Circumflex artery 6(9.5%), OM 3(4.7%), D 2 (3.1%), and LMS protected 2(3.1%).
Further probing of the right coronary cusp demonstrated an anomalous origin of the
circumflex artery. The patient did not have CTO of the circumflex but instead had severe stenosis of his anomalous circumflex (Figure 6).
Coronary angiography revealed three-vessel disease including 90% narrowing of LAD, 80% narrowing of the first diagonal branch (Diag), and 90% narrowing of mid left
circumflex artery.
The important structures at risk are the axillary nerve and the posterior humeral
circumflex artery, the anterior branch of the axillary nerve, and the cephalic vein, biceps tendon, and musculocutaneous nerve.
Congenital right coronary artery (RCA) abberant arises from left
circumflex artery (LCX).
Herein, we presented a case of multilateral coronary fistulas originating from proximal left anterior descending artery (LAD),
circumflex artery (CX) and RCA and terminating in the lung parenchyma with multiple tracts.
The lateral branch gave (I) common humeral
circumflex artery, which divided into anterior and posterior circumflex humeral arteries, the latter continued as the profunda brachii artery.
There was severe stenosis of the native left
circumflex artery (Figure 1(a)); the proximal right coronary artery was completely occluded, and it was supplied distally by bridging collaterals and collaterals from the left
circumflex artery.
