Percutaneous coronary intervention of an obstructive left anterior descending artery with anomalous origin of right coronary artery
A 52-year-old female presented to our center with exertional chest pain for the previous 7 days which had increased in intensity for 1 day. Pain was associated with sweating. She had a history of systemic hypertension but was not on medication. Her elec­trocardiogram showed sinus rhythm with non-specific T-wave abnormalities. Clinical examination revealed a moderately built female with a blood pressure of 140/80mmHg and a regular pulse at 78 beats per minute. Hemoglobin, white cell count, differential white cell count, serum electrolytes, renal function tests, and liver function tests were within normal limits. CK-MB was 28U/L and troponin I was negative. Transthoracic echo showed grade 1 left ventricular (LV) diastolic dysfunction, normal LV systolic function, and no wall motion abnormalities. Cardiac catheterization was done via right radial artery approach. Selective catheterization of the left coronary artery (LCA) showed normal left main (LM) coronary artery, normal left circumflex artery (LCX) coronary artery, and a significant obstructive lesion (80%) in mid part of the left anterior descending artery (LAD) just after the first diagonal branch, with good distal flow ().\nDuring selective catheterization of the LCA, filling in the right coronary artery (RCA) was noted. Attempted cannulation of the RCA was difficult. Nonselective coronary angiography revealed aberrant dominant RCA arising from the left aortic sinus adjacent to the origin of the LCA (). Selective coronary angiography of RCA showed anomalous origin from left aortic sinus; however, RCA had no significant stenotic lesions (). The diagnosis of obstructive LAD lesion with anomalous origin of the RCA from the left aortic sinus was made. The LM artery was engaged with 6 French Judkins left 3.5 guiding catheter (Cordis). A 0.014 inch BMW (Abbott) guidewire was used to cross the lesion. An Integrity 3.5 x 18 mm bare metal stent (Medtronic) was deployed with final good result and Thrombolysis in Myocardial Infarction (TIMI) III flow (). The patient’s subsequent hospital stay was uneventful, and she was discharged home free of angina 3 days later. At 1 month follow-up, patient remained asymptomatic and a treadmill exercise test was negative for inducible myocardial ischemia.