title: Anomalous right coronary artery originating from the mid left anterior descending artery.
abstract: A 68-year-old male with a history of hypertension and hypercholesterolemia presented with recurrent episodes of chest discomfort. A 12-lead ECG and an echocardiogram were normal. A myocardial perfusion study could not rule out ischemia in the inferior wall. At coronary angiography using the transradial approach, the right coronary artery (RCA) could not be visualized. Angiography of the left coronary system demonstrated non-obstructive atherosclerosis involving the mid segment of the left anterior descending (LAD) artery and a normal circumflex (Cx) artery. The RCA originated from the mid LAD segment distal to the first septal perforator and the first diagonal branch and was free of atherosclerosis disease. A contrast-enhanced 64-slice multi-detector cardiac computed tomography showed that the LAD was severely calcified in the proximal part, and the RCA coursed anterior to the right ventricular outflow tract (RVOT) to reach the right atrioventricular groove. The patient was managed medically and became asymptomatic.
authors.affiliation: Department of Interventional Cardiology, University Hospital of Caen, 14033 Caen, France; Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. Electronic address: ziad_dahdouh@hotmail.com.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Dahdouh
authors.affiliation: Department of Interventional Cardiology, University Hospital of Caen, 14033 Caen, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Roule
authors.affiliation: Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
authors.forename: Bahaa M
authors.initials: BM
authors.lastname: Fadel
authors.affiliation: Department of Interventional Cardiology, University Hospital of Caen, 14033 Caen, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Grollier
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography
keywords: Anomalous coronary; Cardiac computed tomography; Coronary angiogram; Right coronary artery; Single coronary artery