Double coronary anomaly: A case report

Abstract

We describe an extremely rare case of a 37-year-old female patient who presented with exertional angina and was diagnosed with a unique coronary anomaly with an anomalous right coronary artery with origin in the left anterior descending artery and a fistula between this anomalous coronary artery and the pulmonary artery.

Learning objectives: Most patients with coronary anomalies are asymptomatic but some may have angina caused by a coronary steal phenomenon, myocardial infarction, or even sudden death depending on the circuit and characteristics of the anomaly.The combination of multiple coronary anomalies is extremely rare.Despite being a rare diagnosis, coronary anomalies should always be considered as a cause of myocardial ischemia, especially in young patients with low probability for coronary obstructive disease.

Keywords: ARCA, anomalous origin of the right coronary artery; Anomalous origin of the right coronary artery; CTA, computed tomography angiography; Chest pain; Congenital heart defect; Coronary fistula; Coronary vessel anomaly; Cx, circumflex artery; Double coronary anomaly; ECG, electrocardiogram; ICA, invasive coronary angiography; LAD, left anterior descending coronary artery; LM, left main coronary artery; PA, pulmonary artery; PDA, posterior descending artery; RCA, right coronary artery; RI, ramus intermedius.