Posterior myocardial infarction caused by superdominant circumflex occlusion over an absent right coronary artery: Case report and review of literature.

RATIONALE

Congenital agenesis of the right coronary artery (CARCA) initially presenting as acute myocardial infarction (AMI) due to total occlusion is a rare clinical condition that can lead to severe complications, including death. We report a case of successful percutaneous coronary intervention (PCI) in a patient with this condition.

PATIENT CONCERNS

A 57-year-old man was admitted to our center with chest pain that had occurred several hours prior. Since he was initially diagnosed with AMI with ST-segment elevation, we promptly commenced coronary angiography (CAG).

DIAGNOSIS

CAG revealed the absence of a right coronary artery (RCA). In the left coronary cusp area, the left circumflex coronary artery (LCX) was occluded totally.

INTERVENTIONS

We performed PCI for total occlusion of the proximal part of the LCX. Follow-up CAG showed a superdominant branch of the LCX, sprouting into the RCA territory.

OUTCOMES

The patient was discharged uneventfully after successful PCI.

LESSONS

CARCA with AMI, which is an extremely unusual case, can be fatal; however, PCI seems to be an effective treatment option.