Rare Congenital Anomalous Origin of the Coronary Arteries: A Series of Three Cases

Introduction: Congenital coronary anomalies are found in 0.3% to 5.6% of the population and can be classified according to alterations in origin, distribution or course. Although benign in most cases, they can be associated with sudden death in young adults, especially after strenuous physical exercise. We report three rare cases of anomalous coronary arteries found incidentally by coronary angiography. Case Report: The first case refers to a 79-year-old man who underwent cardiac catheterization for etiological investigation of heart failure, showing a non-obstructive interruption of the left anterior descending artery (LAD) after the origin of the first diagonal branch, with the continuation of its middle and distal segments from the right coronary artery (RCA), which crosses to the left side at the atrial level and reaches the apex cordis. The second case is a 56-year-old woman with stable angina and a treadmill exercise test suggestive of myocardial ischemia. Coronary angiography revealed an anomalous origin of the RCA from the distal segment of the left circumflex artery (LCxA). The third and last case is a 64-year-old woman in whom coronary angiography revealed an anomalous origin of the LCxA from the proximal third of the RCA. Discussion: Coronary artery anomalies are a heterogeneous group whose diagnosis mostly occurs incidentally. They differ from anatomical variations in their rarity and greater association with adverse events, such as myocardial ischemia and sudden death. The cases presented address different anomalous origins: a LAD with duplicated origin, a single coronary artery with the emergence of the RCA in the distal third of the LCxA, and the anomalous origin of the LCxA from the RCA, one of the most common coronary anomalies. The three cases reported were patients over 50 years old, which shows the need to individualize cases and risks as regarding to anomalous origins of the coronary arteries.