Bypass Grafting of Aberrant Circumflex Artery with Anomalous Origin and Course

Abstract

We present a case of a rarely seen anomalous circumflex (C x) artery originating from the proximal right coronary artery. This was an incidental finding during a diagnostic coronary angiogram performed to investigate a patient with acute coronary syndrome. Surgically significant disease was present in four left-sided vessels. The patient underwent coronary artery bypass grafts using left internal thoracic artery and long saphenous vein grafts to all four left sided vessels including the aberrant C x. We also present a discussion of current relevant literature and guidelines in relation to definition, classification, incidence, diagnosis, clinical relevance and treatment of this type of coronary artery anomalies.

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M. Patronis, S. Papaspyros, K. Shaikhrezai, S. Prasad and D. Agrawal, "Bypass Grafting of Aberrant Circumflex Artery with Anomalous Origin and Course," Open Journal of Thoracic Surgery, Vol. 2 No. 4, 2012, pp. 121-125. doi: 10.4236/ojts.2012.24025.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] P. Angelini, “Coronary Artery Anomalies: An Entity in Search of an Identity,” Circulation, Vol. 115, No. 10, 2007, pp. 1296-1305.
[2] A. Dodge-Khatami, C. Mavroudis and C. L. Backer, “Congenital Heart Surgery Nomenclature and Database Project: Anomalies of the Coronary Arteries,” The Annals of Thoracic Surgery, Vol. 69, No. 3, 2000, pp. 270-297. doi:10.1016/S0003-4975(99)01248-5
[3] R. W. Alexander and G. C. Griffith, “Anomalies of the Coronary Arteries and Their Clinical Significance,” Circulation, Vol. 14, No. 5, 1956, pp. 800-805. doi:10.1161/01.CIR.14.5.800
[4] P. Angelini, “Coronary Artery Anomalies: A Comprehensive Approach,” Lippincott Williams & Wilkins, Philadelphia, 1999.
[5] O. Yamanaka and R. E. Hobbs, “Coronary Artery Anomalies in 126,595 Patients Undergoing Coronary Arteriography,” Catheterization and Cardiovascular Diagnosis, Vol. 21, No. 1, 1990, pp. 28-40. doi:10.1002/ccd.1810210110
[6] O. Topaz, E. J. De Marchena, E. Perin, L. S. Sommer, S. M. Mallon and R. A. Chahine, “Anomalous Coronary Arteries: Angiographic Findings in 80 Patients,” International Journal of Cardiology, Vol. 34, No. 2, 1992, pp. 129-138. doi:10.1016/0167-5273(92)90148-V
[7] C. E. Wilkins, B. Betancourt, V. S. Mathur, A. Massumi, C. M. De Castro, E. Garcia and R. J. Hall, “Coronary Artery Anomalies: A Review of More than 10,000 Patients from the Clayton Cardiovascular Laboratories,” Texas Heart Institute Journal, Vol. 15, No. 3, 1988, pp. 166-173.
[8] N. Garg, S. Tewari, A. Kapoor, D. K. Gupta and N. Sinha, “Primary Congenital Anomalies of the Coronary Arteries: A Coronary Arteriographic Study,” International Journal of Cardiology, Vol. 74, No. 1, 2000, pp. 39-46. doi:10.1016/S0167-5273(00)00243-6
[9] A. Yildiz, B. Okcun, T. Peker, C. Arslan, A. Olcay and M. B. Vatan, “Prevalence of Coronary Artery Anomalies in 12,457 Adult Patients Who Underwent Coronary Angiography,” Clinical Cardiology, Vol. 33, No. 12, 2010, pp. E60-E64. doi:10.1002/clc.20588
[10] W. Antopol and M. A. Kucel, “Anomalous Origin of the Left Circumflex Coronary Artery,” American Heart Journal, Vol. 8, No. 6, 1933, pp. 802-806. doi:10.1016/S0002-8703(33)90141-6
[11] H. L. Page Jr., H. J. Engel, W. B. Campbell and C. S. Thomas Jr., “Anomalous Origin of the Left Circumflex Coronary Artery. Recognition, Angiographic Demonstration and Clinical Significance,” Circulation, Vol. 50, No. 4, 1974, pp. 768-773. doi:10.1161/01.CIR.50.4.768
[12] R. R. Liberthson, “Sudden Death from Cardiac Causes in Children and Young Adults,” New England Journal of Medicine, Vol. 334, No. 16, 1996, pp. 1039-1044. doi:10.1056/NEJM199604183341607
[13] B. J. Maron, J. Shirani, L. C. Poliac, R. Mathenge, W. C. Roberts and F. O. Mueller, “Sudden Death in Young Competitive Athletes: Clinical, Demographic, and Pathological Profiles,” Journal of the American Medical Association, Vol. 276, No. 3, 1996, pp. 199-204. doi:10.1001/jama.1996.03540030033028
[14] A. J. Taylor, J. P. Byers, M. D. Cheitlin and R. Virmani, “Anomalous Right or Left Coronary Artery from the Contralateral Coronary Sinus: ‘High-Risk’ Abnormalities in the Initial Coronary Artery Course and Heterogeneous Clinical Outcomes,” American Heart Journal, Vol. 133, No. 4, 1997, pp. 428-435. doi:10.1016/S0002-8703(97)70184-4
[15] R. E. Eckart, S. L. Scoville, C. L. Campbell, E. A. Shry, K. C. Stajduhar, R. N. Potter, L. A. Pearse and R. Virmani, “Sudden Death in Young Adults: A 25-Year Review of Autopsies in Military Recruits,” Annals of Internal Medicine, Vol. 141, No. 11, 2004, pp. 829-834.
[16] P. Angelini, “Coronary Artery Anomalies—Current Clinical Issues De?nitions, Classi?cation, Incidence, Clinical Relevance, and Treatment Guidelines,” Texas Heart Institution Journal, Vol. 29, No. 4, 2002, pp. 271-278.
[17] 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,” Circulation, Vol. 118, No. 23, 2008, pp. e714-e833. doi:10.1161/CIRCULATIONAHA.108.190690
[18] H. Baumgartner, P. Bonhoeffer, N. De Groot, et al., “ESC Guidelines for the Management of Grown-Up Congenital Heart Disease (New Version 2010): The Task Force on the Management of Grown-Up Congenital Heart Disease of the European Society of Cardiology,” European Heart Journal, Vol. 31, No. 23, 2010, pp. 2915-2957. doi:10.1093/eurheartj/ehq249
[19] G. Rigatelli, M. Gemelli, A. Zamboni, G. Docali, P. Rossi, D. Rossi, et al., “Are Coronary Artery Anomalies an Accelerating Factor for Coronary Atherosclerosis Development?” Angiology, Vol. 55, No. 1, 2004, pp. 29-35. doi:10.1177/000331970405500105
[20] P. Angelini, R. P. Walmsley, A. Libreros and D. A. Ott, “Symptomatic Anomalous Origination of Left Coronary Artery from the Opposite Sinus of Valsalva: Clinical Presentations, Diagnosis, and Surgical Repair,” Texas Heart Institute Journal, Vol. 33, No. 2, 2006, pp. 171-179.
[21] E. D. Fernandes, H. Kadivar, G. L. Hallman, G. J. Reul, D. A. Ott and D. A. Cooley, “Congenital Malformations of the Coronary Arteries: The Texas Heart Institute Experience,” Annals of Thoracic Surgery, Vol. 54, No. 4, 1992, pp. 732-740. doi:10.1016/0003-4975(92)91019-6
[22] R. M. Reul, D. A. Cooley, G. L. Hallman and G. J. Reul, “Surgical Treatment of Coronary Artery Anomalies: Report of a 37.5-Year Experience at the Texas Heart Institute,” Texas Heart Institute Journal, Vol. 29, No. 4, 2002, pp. 299-307.
[23] R. A. Krasuski, D. Magyar, S. Hart, V. Kalahasti, R. Lorber, R. Hobbs, G. Pettersson and E. Blackstone, “Long-Term Outcome and Impact of Surgery on Adults with Coronary Arteries Originating from the Opposite Coronary Cusp,” Circulation, Vol. 123, No. 2, 2011, pp. 154-162. doi:10.1161/CIRCULATIONAHA.109.921106

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