Superdominant Left Circumflex Artery with Absent Right Coronary Artery

HomeRadiologyVol. 304, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologySuperdominant Left Circumflex Artery with Absent Right Coronary ArteryArzu Canan , Kiran BatraArzu Canan , Kiran BatraAuthor AffiliationsFrom the Department of Radiology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9316.Address correspondence to A.C. (email: [email protected]).Arzu Canan Kiran BatraPublished Online:Apr 19 2022https://doi.org/10.1148/radiol.213178MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 77-year-old woman with hypertension and diabetes mellitus presented with syncope. An electrocardiogram revealed third-degree heart block. Prospectively electrocardiographically triggered coronary CT angiography revealed a single left coronary artery, immediately bifurcating into a superdominant left circumflex (LCX) artery and a small left anterior descending artery (Figure). No right coronary artery (RCA) was identified. The LCX artery was superdominant, as it extended into the right atrioventricular groove and supplied the RCA territory. It also gave origin to posterior descending, posterolateral branch, and sinoatrial nodal arteries. No obstructive coronary atherosclerosis, myocardial bridging, or structural heart disease was identified. Nuclear myocardial perfusion imaging was also normal. The coronary variant was accepted as incidental and noncontributory to the syncope and heart block in the patient.Three-dimensional cinematic rendered images of a heart demonstrate superdominant left circumflex (LCX) artery supplying the right coronary artery territory. LAD = left anterior descending artery.Download as PowerPointOpen in Image Viewer Single coronary artery is a rare coronary anomaly, with an incidence of less than 0.066%, and may be isolated or accompanied by congenital abnormalities such as bicuspid aortic valve, coronary artery fistula, and hypertrophic cardiomyopathy (1,2). The patients are usually asymptomatic but might present with ischemic symptoms related to concurrent coronary atherosclerosis or interarterial course (3). In our case, the coronary variant was accepted as noncontributory to patient’s symptoms. The patient had a pacemaker placed and reported no other episodes at the follow-up.Disclosures of conflicts of interest: A.C. No relevant relationships. K.B. No relevant relationships.References1. Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology 1979;130(1):39–47. Link, Google Scholar2. Desmet W, Vanhaecke J, Vrolix M, et al. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J 1992;13(12):1637–1640. Crossref, Medline, Google Scholar3. Said SA, de Voogt WG, Bulut S, et al. Coronary artery disease in congenital single coronary artery in adults: A Dutch case series. World J Cardiol 2014;6(4):196–204. Crossref, Medline, Google ScholarArticle HistoryReceived: Dec 15 2021Revision requested: Dec 22 2021Revision received: Dec 23 2021Accepted: Jan 3 2022Published online: Apr 19 2022Published in print: Aug 2022 FiguresReferencesRelatedDetailsRecommended Articles Abnormalities of the Coronary Arteries in Children: Looking beyond the OriginsRadioGraphics2017Volume: 37Issue: 6pp. 1665-1678Cardiovascular CT and MRI in 2020: Review of Key ArticlesRadiology2021Volume: 301Issue: 2pp. 263-277CAD-RADS: Pushing the LimitsRadioGraphics2020Volume: 40Issue: 3pp. 629-652Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical Entity—A Primer for Cardiac ImagersRadioGraphics2021Volume: 41Issue: 7pp. 1897-1915Hypertrophic Cardiomyopathy from A to Z: Genetics, Pathophysiology, Imaging, and ManagementRadioGraphics2016Volume: 36Issue: 2pp. 335-354See More RSNA Education Exhibits Out on the Road: Revisiting Coronary Artery AnomaliesDigital Posters2022Pearls and Pitfalls in Cardiac ImagingDigital Posters2022Myocardial Perfusion Imaging: Past, Present, and FutureDigital Posters2022 RSNA Case Collection Anomalous origin of the right coronary artery from the left sinus of ValsalvaRSNA Case Collection2020Hypertrophic cardiomyopathyRSNA Case Collection2020Cardiac AmyloidosisRSNA Case Collection2020 Vol. 304, No. 2 Metrics Altmetric Score PDF download