CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 5, September/October 2010
286
AFRICA
Case Report
Congenital absence of the left circumflex coronary
artery and an unusually dominant course of the right
coronary artery
M BASKURT, B OKCUN, IM CAGLAR, AA OZKAN, M ERSANLI, T GURMEN
Summary
Congenital absence of the left circumflex artery (LCX) is a
very rare congenital anomaly of the coronary circulation,
and only a few cases have been reported in the literature.
We report on a 55-year-old female with atypical chest pain.
Routine coronary angiography showed a normal left anterior
descending coronary artery (LAD), no LCX and a dominant
right coronary artery (RCA), which continued beyond the
crux, running the full course of the LCX and terminating in
the left atrial branch. Neither aortography nor pulmonary
angiography showed a separate ostium for the LCX. There
were no atherosclerotic lesions in the coronary arteries, or
ischaemia on stress myocardial perfusion imaging. Multi-
detector row computed tomography (MDCT) was performed
to confirm the diagnosis.
Keywords:
angiography, coronary heart disease, coronary
vessels
Submitted 31/8/09, accepted 10/3/10
Cardiovasc J Afr
2010; 21: 00–00
Various coronary artery anomalies have been described in the
literature, with a range of occurrence from 0.6 to 1.3%, and
mostly diagnosed incidentally.
1
Congenital absence of the left
circumflex coronary artery (LCX) is an extremely rare condi-
tion, and only a few cases have been reported.
2-16
We report on
a patient with atypical symptoms, an absent LCX and super-
dominant right coronary artery (RCA).
Case report
A 55-year-old female with atypical chest pain for the previous
two years was admitted to our hospital. She had had type 2 diabe-
tes for 10 years. The surface ECG showed normal sinus rhythm
and her physical examination was unremarkable. Chest X-ray
and two-dimensional echocardiography were normal.
She underwent elective coronary angiography with a standard
right femoral approach. The left coronary angiogram showed
only the left anterior descending coronary artery (LAD) arising
from the left sinus of Valsalva and no LCX was seen with a left
injection (Fig. 1a–c). The right coronary artery (RCA) originated
normally from the right sinus of Valsalva. It had a normal course
and continued beyond the crux through the left atrio-ventricular
sulcus, running the full course of the LCX and terminating in the
left atrial branch (Fig. 1d). Neither aortography nor pulmonary
angiography showed a separate ostium for the LCX. The RCA
supplied blood to the posterolateral and lateral walls of the left
ventricle, so it was considered a super-dominant RCA. There was
no stenosis in either the LAD or RCA.
Cardiology Department, Institute of Cardiology, Istanbul
University, Istanbul
MURAT BASKURT, MD,
BARIS OKCUN, MD
ILKER M CAGLAR, MD
ALEV A OZKAN, MD
MURAT ERSANLI, MD
TEVFİK GURMEN, MD
Fig. 1. The left circumflex artery is not seen in various
views in conventional coronary arteriography. (A) The left
circumflex artery is absent in this view (LAO 0°, caudal
20°). Note that the contrast in the left sinus of Valsalva
does not indicate another possible ostium of the circum-
flex artery. (B) In this view the left anterior descending
artery is clearly visualised (LAO 40°, cranial 20°). (C) This
view is taken from LAO 0° and cranial 40°. Again only the
left anterior descending artery is seen. (D) The right coro-
nary artery continues in the posterior atrio-ventricular
groove and terminates in the left atrial branch. The super-
dominant right coronary artery (LAO 0° cranial 0°). LAO:
left anterior oblique.
A
B
C
D
