Answer for BIR CoW 28 Mar 2021
Superdominant right coronary artery with absent left circumflex artery
Findings
Single left anterior descending artery with multiple prominent diagonal branches Superdominant good sized right coronary artery with absent left circumflex artery in the atrioventricular groovenoted There was no flow limiting significant stenosis in the visualized epicardial coronary arteries.
Discussion
Congenital absence of left circumflex coronary artery is an extremely rare anomaly with a reported incidence between 0.003% and 0.067%. It is invariably associated with right dominant circulation. Patients with congenital absence of LCX can present with variable symptoms ranging from dyspnea on exertion to acute onset myocardial infarction. Complete absence results from agenesis of LCX in the left atrioventricular groove. In this condition, lateral wall of the left ventricle is supplied by a super-dominant right coronary artery or occasionally by a multiple diagonal branches of LAD Pts present with exertional chest pain. One hypothesis that can explain exertional symptoms is steal phenomenon. This phenomenon results from increased metabolic demands in the LCX territory resulting in ischemic changes in LAD or RCA territories mimicking an acute coronary event. Hence ,Recognition of this anomaly is important, as it may mimic atherosclerotic coronary artery disease, where oxygen demand in myocardium normally supplied by it is taken over by RCA and such supply may not be sufficient during increased physical activity.
Ref: Case Reports in cardiology Volume 2017 |Article ID 8710135 | https://doi.org/10.1155/2017/8710135 Absence of Left Circumflex Artery: A Rare Congenital Disorder of Coronary Arteries
Findings
Single left anterior descending artery with multiple prominent diagonal branches Superdominant good sized right coronary artery with absent left circumflex artery in the atrioventricular groovenoted There was no flow limiting significant stenosis in the visualized epicardial coronary arteries.
Discussion
Congenital absence of left circumflex coronary artery is an extremely rare anomaly with a reported incidence between 0.003% and 0.067%. It is invariably associated with right dominant circulation. Patients with congenital absence of LCX can present with variable symptoms ranging from dyspnea on exertion to acute onset myocardial infarction. Complete absence results from agenesis of LCX in the left atrioventricular groove. In this condition, lateral wall of the left ventricle is supplied by a super-dominant right coronary artery or occasionally by a multiple diagonal branches of LAD Pts present with exertional chest pain. One hypothesis that can explain exertional symptoms is steal phenomenon. This phenomenon results from increased metabolic demands in the LCX territory resulting in ischemic changes in LAD or RCA territories mimicking an acute coronary event. Hence ,Recognition of this anomaly is important, as it may mimic atherosclerotic coronary artery disease, where oxygen demand in myocardium normally supplied by it is taken over by RCA and such supply may not be sufficient during increased physical activity.
Ref: Case Reports in cardiology Volume 2017 |Article ID 8710135 | https://doi.org/10.1155/2017/8710135 Absence of Left Circumflex Artery: A Rare Congenital Disorder of Coronary Arteries
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!