Morais Humberto, Lacerda Rafael, Kapenda Afonso, Mbala Cláudio L, Martins Telmo, Fernandes Elsa, Gonçalves Mauer
Cardiology Department, Hospital Militar Principal/Instituto Superior, Luanda, AGO.
Internal Medicine Department, Medical School of Juazeiro do Norte, Juazeiro do Norte, BRA.
Cureus. 2024 Nov 21;16(11):e74130. doi: 10.7759/cureus.74130. eCollection 2024 Nov.
Coronary artery anomalies (CAAs) are rare and challenging, with increased diagnoses due to advanced cardiovascular imaging, even in low-income countries where diagnostic and therapeutic approaches can be difficult. This case report details a 65-year-old Black male patient with a history of hypertension and smoking who presented with a myocardial infarction. Despite no significant abnormalities apart from the infarction, invasive coronary angiography revealed a dominant right coronary artery (RCA) and an anomalous left main coronary artery (LMCA) originating from the right coronary sinus, bifurcating into the left anterior descending artery and circumflex artery. An 80% stenotic lesion in the distal RCA was treated with percutaneous transluminal coronary angioplasty (PTCA) and drug-eluting stent implantation. Coronary computed tomography angiography (CCTA) confirmed the findings, detailing the anomalous LMCA's course. This case underscores the rarity and clinical significance of CAAs, particularly an anomalous LMCA with a septal course, as a diagnostic challenge and the impact of course study on therapeutic decision-making. While conservative treatment is generally recommended, surgical intervention may be necessary for high-risk cases. For this patient, the current myocardial infarction was due to atherosclerotic disease in the RCA, effectively treated with PTCA and stent placement. The percutaneous treatment of RCA stenosis, despite the anomalous LMCA without significant atherosclerosis, appears to be effective and safe.
冠状动脉异常（CAA）较为罕见且具有挑战性，随着心血管成像技术的进步，其诊断率有所增加，即便在诊断和治疗方法可能存在困难的低收入国家也是如此。本病例报告详细介绍了一名65岁的黑人男性患者，有高血压和吸烟史，因心肌梗死前来就诊。除梗死外无明显异常，但侵入性冠状动脉造影显示为右优势型冠状动脉（RCA），以及一条起源于右冠状动脉窦的异常左主干冠状动脉（LMCA），该左主干冠状动脉分为左前降支动脉和回旋动脉。对远端RCA中一处80%狭窄病变进行了经皮冠状动脉腔内血管成形术（PTCA）和药物洗脱支架植入治疗。冠状动脉计算机断层扫描血管造影（CCTA）证实了这些发现，并详细显示了异常LMCA的走行。本病例强调了CAA的罕见性和临床意义，尤其是走行于间隔的异常LMCA，它是一种诊断挑战，以及走行研究对治疗决策的影响。虽然一般建议采取保守治疗，但高风险病例可能需要手术干预。对该患者而言，当前的心肌梗死是由RCA的动脉粥样硬化疾病所致，通过PTCA和支架置入得到了有效治疗。尽管存在异常LMCA且无明显动脉粥样硬化，但对RCA狭窄进行经皮治疗似乎是有效且安全的。
