Anomalous origin of left circumflex artery from the right pulmonary artery of an adult

Abstract

To the Editor, The anomalous origin of coronary arteries is a rare entity (overall rate < 1 for every 300 000 live births), and often appears concomitantly with other congenital heart defects.1 The anomalous origin of the left circumflex artery (LCx) from the right coronary artery (RCA), the right sinus of Valsalva or the separate origin of the left anterior descending coronary artery (LAD) and LCx all have been reported.2,3 However, an anomalous origin of the LCx from the pulmonary artery (PA) or its branches is extremely rare.4 A 39-year-old male presented with palpitations and atypical chest pain of 12-hour duration in a context of vomits, diarrhea, and abdominal pain. Three weeks prior to admission he had reported the presence of catarrhal symptoms. Prior to the current admission the patient recounted several episodes of chest tightness while performing high-intensity physical exercise. The patient’s past medical history included a non-dysfunctional bicuspid aortic valve and aortic coarctation. Coarctation was initially corrected (1995) with a subclavian artery-to-descending aorta bypass graft. Ten years later he underwent further surgical repair using an interposition tube graft. A diagnosis of acute myocarditis was considered likely. Upon admission the electrocardiogram showed sinus rhythm with normal progression of R waves and...