Pathangey Girish, Allam Mohamed A, Abdelnabi Mahmoud H, Ibrahim Ramzi, Sarkis Patrick, Pathangey Sachin, Sell-Dottin Kristen, Ayoub Chadi, Marcotte Francois, Narayanasamy Hemalatha
Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona, USA.
Department of Cardiovascular Disease, Mayo Clinic, Phoenix, Arizona, USA.
JACC Case Rep. 2025 Jun 25;30(16):104204. doi: 10.1016/j.jaccas.2025.104204.
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.
TAKE-HOME MESSAGE: Clinical suspicion for coronary anomalies may warrant multimodal imaging and multidisciplinary approach for risk stratification and outcome optimization.
冠状动脉异常在人群中的发生率为0.03%至0.28%,起源于右肺动脉的异常左旋支动脉(AoLCx-RPA)是一个罕见的亚组,与缺血风险增加和心源性死亡相关。鉴于相关指南有限,早期识别和功能评估对于优化管理至关重要。
我们报告一名43岁男性,既往无重大病史,出现1个月的劳力性呼吸困难、心电图改变及肌钙蛋白升高,提示非ST段抬高型心肌梗死。冠状动脉造影显示动脉无阻塞,通过右冠状动脉侧支逆行充盈,提示左旋支动脉异常。包括计算机断层血管造影、心脏磁共振和正电子发射断层扫描在内的多模态成像证实了AoLCx-RPA合并缺血,促使进行手术矫正。
本病例突出了AoLCx-RPA的诊断和治疗途径,为有限的证据做出了贡献。我们讨论了当前指南、多模态成像在评估解剖和功能意义方面的作用以及先进的混合成像在管理中的效用。
对冠状动脉异常的临床怀疑可能需要多模态成像和多学科方法进行风险分层和优化结局。