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Anomalous origin of the right coronary artery from the left anterior descending artery: a rare subtype of single coronary artery anomaly

A 61-year-old woman presented to the cardiology clinic with exertional chest pain typical of angina. She was a smoker with a positive family history of premature coronary heart disease. Exercise electrocardiogram was inconclusive and amyocardial perfusion scanwas normal, but due to the typical and persistent nature of her symptoms coronary angiography was carried out. Aortography showed a solitary coronary artery arising from the left aortic sinus (Fig. 1). Selective cannulation of the isolated left coronary artery showed an anomalous origin of the right coronary artery (RCA) arising from the left anterior descending (LAD) artery after the first septal perforator (Fig. 2). This vessel traversed the anterior surface of the heart before supplying the right ventricle and inferior wall of the left ventricle. No significant stenoses were noted. The prevalence of coronary artery abnormalities and anomalous RCA have been reported as 1.3 and 0.26%, respectively, in a large series of 126 595 coronary angiograms. The prevalence of single coronary artery is approximately 0.024%. This particular variation of anomalous RCA arising from the LAD is extremely rare, however, and the authors believe that this is only the 11th case reported in the publishedwork. This variation is usually associatedwith a benign prognosis in comparison to other variations of anomalous RCA, which arisemore proximally from the left coronary artery. These variations can be associated with sudden death, particularly if the anomalous vessel passes between the aortic root and the main pulmonary artery.