Anomalous Origin of Left Anterior Descending and Left Circumflex Arteries From the Proximal Right Coronary Arteries Individually With an Absent Left Main Coronary Artery: A Case Report

The most common coronary artery anomaly (CAA) observed in patients undergoing coronary angiography is the anomalous left circumflex (LCx) coronary artery, which originates from the right coronary artery (RCA) or the right sinus of the Valsalva (RCx). There are restricted reports on the anomalous origin of the left anterior descending (LAD) and LCx arteries from the proximal RCA separately in coeval with an absent left main coronary artery (LMCA). Here, we describe a case of a 31-year-old female with obesity, type 2 diabetes, and hypertension risk factors who presented to the emergency care unit of our hospital with the chief complaints of chest pain and dyspnea for the past two days. Computed tomography angiography (CTA) has detected her incidentally with the unusual presentation of anomalous origination of LCx and LAD from the proximal RCA and the absent LMCA. Hence, our reported patients had R-III-A subsets of single coronary artery (SCA) type with Lipton-Yamanaka classification. The current case report, which documents the rarity of a unique variant, also advocates for genetic profiling or testing, routine imaging screening in individuals with risk factors such as hypertension, etc., for aberrant coronaries involving its origin, course, and termination. This case report primarily demonstrates the critical role of coronary CTA in providing a thorough assessment of the coronary anatomy so that an appropriate decision on the intervention required for the respective variant pathologies can be made.