Author + information
- Won-Kyung Lee1
Patient initials or identifier number
Relevant clinical history and physical exam
A 63-year-old male visited emergency department due to resting chest pain for several days. He was taking medications for hypertension and dyslipidemia. He underwent PCI with stenting at mid LAD and diagonal branch three years ago. His heart sound was regular without murmur and lung sound was clear. There were no abnormal physical findings such as edema or neck vein engorgement.
Relevant test results prior to catheterization
The previous CAG showed tubular eccentric 70% luminal narrowing at mid LAD and tubular 85% luminal narrowing at D1. Circumflex artery not seen. We could not find where the Circumflex ostium is. The right coronary artery had 50% and 60% tandem lesion at mid and distal segments.
Relevant catheterization findings
The previous stent at mid LAD was patent. RCA had no interval changes over three years, and still, we could not find LCX territory artery ostium.
Therefore, we decided to check up the LCX by coronary CT.
Coronary CT angiography
Coronary CT angiography revealed LCX ostium originated from right coronary cusp under the RCA ostium with diffuse significant stenosis.
We can engage to the LCX ostium with right Judkins guiding catheter at the site of the right coronary cusp, which detected in coronary CT angiography. CAG revealed diffuse irregular up to 90% luminal narrowing at proximal LCX with TIMI 1 flow. DEB (Sequent please 2.5 x 30 mm) was inflated at the proximal LCX lesion successfully and follow-up angiography showed 40% residual stenosis with TIMI 3 flow.
After PCI, the patient followed up without chest pain with good exercise capacity.
Coronary CT angiography was helpful to find the coronary artery ostium from the anomalous origin. We report that a rare case of anomalous origin of LCX ostium from RCC by finding coronary CT angiography.