Anomalous Right Coronary Artery with LV Non-compaction having Malignant Course, A Rare but Lethal Combination

Anomalous Right Coronary Artery with LV Non-compaction having Malignant Course, A Rare but Lethal Combination

Ahmad Hasan1, Fahar Adnan2, Shahzad Shoukat1, Umer Aftab1, Muhammad Waqas1, Muhammad Iqbal1

1Allama Iqbal Medical College/Jinnah Hospital, (Allama Shabbir Usmani road, Faisal town) Lahore, Pakistan.
2Senior Registrar Department of Cardiology, multan Institute of Cardiology, Multan

International-Journal-of-Case-Reports-2d code

Anomalous Right coronary Artery origin from contralateral sinus is a rare but lethal variant that may mimic like acute coronary syndrome and is a potential cause of sudden cardiac death. This needs early diagnosis with prompt treatment which may be conservative or interventional depending upon the clinical presentation, exact anatomy and route of the vessel. Here we present a unique case of combination of anomalous right coronary artery origin from opposite sinus causing ischemia, with LV non-compaction ending in non-hemorrhagic stroke.

Keywords: Anomalous coronary artery, inter-arterial course, computed angiography.

Free Full-text PDF

How to cite this article:
Ahmad Hasan, Fahar Adnan, Shahzad Shoukat, Umer Aftab, Muhammad Waqas, Muhammad Iqbal.Anomalous Right Coronary Artery with LV Non-compaction having Malignant Course, A Rare but Lethal Combination. International Journal of Case Reports, 2018 3:41. DOI:10.28933/ijcr-2018-10-1001


1. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21:28-40.
2. P. Angelini, S. Villason, A.V. Chan, G. Diez Coronary artery anomalies: a comprehensive approach Lippincott Williams & Wilkins, Philadelphia (PA) (1999).
3. Garg N, Tewari S, Kapoor A, et al. Primary congenital anomalies of the coronary arteries: a coronary arteriographic study. Int J Cardiol 2000; 74:39-46.
4. J.M. Penalver, R.S. Mosca, D. Weitz, C.K. PhoonAnomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk BMC Cardiovasc Disord, 12 (2012), p. 83, 10.1186/1471-2261-12-83
5. Taylor A.J., Rogan K.M., Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992; 20(3):640–647.
6. Cha KS, Kim HK, Cun KJ, et al. Role of transesophageal echocardiography in indentifying anomalous origin and course of coronary arteries. Korean Circ J. 1998; 28:576–585.
7. Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography. Datta J, White CS, Gilkeson RC, Meyer CA, Kansal S, Jani ML, Arildsen RC, Read K Radiology. 2005 Jun; 235(3):812-8.
8. Magnetic resonance imaging demonstration of anomalous origin of the right coronary artery from the left coronary sinus associated with acute myocardial infarction. Lee J, Choe YH, Kim HJ, Park JE J Comput Assist Tomogr. 2003 Mar-Apr; 27(2):289-91.
9. J. Datta, C.S. White, R.C. Gilkeson, et al.Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography Radiology, 235 (2005), p. 812
10. M. Cohenpour, A. Tourovski, I. Zyssman, et al.Anomalous origin of left main coronary artery: the value of myocardial scintigraphic and spiral computed tomography scans Nucl Med Rev Cent East Eur, 9 (2006), pp. 69-71
11. Hutchins GM, Miner MM, Boitnott JK. Vessel caliber and branch-angle of human coronary artery branch-points. Circ Res. 1976; 38:572–576.
12. Liu LB, Richardson T, Taylor CB. Atherosclerotic occlusions in anomalous left circumflex coronary arteries. A report of 2 unusual cases and a review of pertinent literature. Paroi Arterielle. 1975; 3:55–59.
13. Witt BJ, Brown RD, Jr, Jacobsen SJ, et al. A community-based study of stroke incidence after myocardial infarction. Ann Intern Med. 2005; 143:785–92.
14. Martin R, Bogousslavsky J. Mechanism of late stroke after myocardial infarct: the Lausanne Stroke Registry. J Neurol Neurosurg Psychiatry1993;56:760-764
15. Evan Loh, M.D., Martin St. John Sutton, M.D. Ventricular Dysfunction and the Risk of Stroke after Myocardial Infarction N Engl J Med 1997; 336:251-257
16. Asinger RW, Mikell FL, Elsperger J, Hodges M. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. N Engl J Med. 1981 Aug 6;305(6):297-302
17. Isolated noncompaction of the myocardium in adults
Ritter M, Oechslin E, Sutsch G, Attenhofer C, Schneider J, Jenni R.
Mayo Clin Proc 1997;72:26 –31
18. Oechslin EN, Attenhofer Jost CH, Rojas JR, et al. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 36:493–500.
19. Belanger AR, Miller MA, Donthireddi UR, Najovits AJ, Goldman ME. New classification scheme of left ventricular noncompaction and correlation with ventricular performance. Am J Cardiol 2008; 102:92-6.
20. C.A. Warnes, R.G. Williams, T.M. Bashore, et al.ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Developed in collaboration with the American Society of Echocardiography, Heart RhythmSociety, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society ofThoracic Surgeons J Am Coll Cardiol, 52 (2008), pp. e143-e263) the patient was waiting for surgery when he developed stroke which was then managed conservatively.