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

      case-report

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          Abstract

          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.

          Related collections

          Most cited references28

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          Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.

          Coronary artery anomalies were found in 1,686 patients (1.3% incidence) undergoing coronary arteriography at the Cleveland Clinic Foundation from 1960 to 1988. Of the 1,686 patients, 1,461 (87%) had anomalies of origin and distribution, and 225 (13%) had coronary artery fistulae. Most coronary anomalies did not result in signs, symptoms, or complications, and usually were discovered as incidental findings at the time of catheterization. Eighty-one percent were "benign" anomalies: 1) separate origin of the left anterior descending and circumflex from the left sinus of Valsalva; 2) ectopic origin of the circumflex from the right sinus of Valsalva; 3) ectopic coronary origin from the posterior sinus of Valsalva; 4) anomalous coronary origin from the ascending aorta; 5) absent circumflex; 6) intercoronary communications; and 7) small coronary artery fistulae. Other anomalies may be associated with potentially serious sequelae such as angina pectoris, myocardial infarction, syncope, cardiac arrhythmias, congestive heart failure, or sudden death. Potentially serious anomalies include: 1) ectopic coronary origin from the pulmonary artery; 2) ectopic coronary origin from the opposite aortic sinus; 3) single coronary artery; and 4) large coronary fistulae. Coronary artery anomalies require accurate recognition, and at times, surgical correction.
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            Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography.

            The aim of our study was to evaluate the diagnostic accuracy of multislice computed tomography (MSCT) coronary angiography using a new 64-slice scanner. The new 64-slice MSCT scanner has improved spatial resolution of 0.4 mm and a faster rotation time (330 ms) compared to prior MSCT scanners. We studied 70 consecutive patients undergoing elective invasive coronary angiography. Patients were excluded for atrial fibrillation, but not for high heart rate, coronary calcification, or obesity. All vessels were analyzed, including those 70 beats/min, and 50% were obese. Specificity, sensitivity, and positive and negative predictive values for the presence of significant stenoses were: by segment (n = 935), 86%, 95%, 66%, and 98%, respectively; by artery (n = 279), 91%, 92%, 80%, and 97%, respectively; by patient (n = 70), 95%, 90%, 93%, and 93%, respectively. Our results indicate high quantitative and qualitative diagnostic accuracy of 64-slice MSCT in comparison to QCA in a broad spectrum of patients.
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              Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.

              Isolated single coronary artery is a rare congenital anomaly occuring in approximately 0.024% of the population. This entity can be diagnosed during life only by coronary angiography. Ten patients with isolated single coronary artery are reported. Based on angiographic analysis, a new classification is proposed, according to the site of origin and anatomical distribution of the branches. Typical angina did not occur with single coronary artery in the absence of coexisting coronary artery disease or aortic stenosis. No correlation was apparent between the type of anomalous patterns and the symptoms of angina.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                09 July 2021
                09 July 2021
                : 100
                : 27
                : e26604
                Affiliations
                Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
                Author notes
                []Correspondence: Ju Han Kim, Department of Cardiology, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Korea (e-mail: kim@ 123456zuhan.com ).
                Article
                MD-D-21-01837 26604
                10.1097/MD.0000000000026604
                8270598
                34232213
                a49e6b87-385f-4c85-8c7d-89eca527d8c4
                Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 8 March 2021
                : 20 May 2021
                : 22 June 2021
                Categories
                3400
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                acute myocardial infarction,percutaneous coronary intervention,right coronary artery absence

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