Anomalous Left Circumflex Origin From Right Pulmonary Artery: Concern for Coronary Steal Revealed by Multimodal Imaging

TL;DR

A rare heart condition involving an abnormal artery was diagnosed and treated using advanced imaging techniques.

Contribution

This case study demonstrates the use of multimodal imaging to diagnose and guide treatment for a rare coronary artery anomaly.

Findings

Multimodal imaging confirmed anomalous left circumflex artery from right pulmonary artery with ischemia.

Surgical correction was performed following diagnostic imaging and multidisciplinary evaluation.

The case emphasizes the importance of imaging and collaboration in managing rare coronary anomalies.

Abstract

Coronary artery anomalies occur in 0.03% to 0.28% of the population, with anomalous left circumflex artery from right pulmonary artery (AoLCx-RPA) a rare subset associated with increased ischemia risk and cardiac death. Early recognition and functional assessment are essential for optimal management given limited guidelines.

We present a 43-year-old man with no significant history who developed 1-month exertional dyspnea, electrocardiographic changes, and elevated troponin concerning for non–ST-segment elevation myocardial infarction. Coronary angiography revealed nonobstructive arteries with retrograde filling via right coronary artery collaterals, suggestive of anomalous left circumflex artery. Multimodal imaging—including computed tomography angiography, cardiac magnetic resonance, and positron emission tomography—confirmed AoLCx-RPA with ischemia, prompting surgical correction.

This case highlights diagnostic and treatment pathways for AoLCx-RPA, contributing to limited evidence. We discuss current guidelines, multimodal imaging's role in evaluating anatomic and functional significance, and advanced hybrid imaging's utility in management.

Clinical suspicion for coronary anomalies may warrant multimodal imaging and multidisciplinary approach for risk stratification and outcome optimization.

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