Anomalous Right Coronary Artery Arising From Distal Left Circumflex Artery
Notice bibliographique
Résumé
Single coronary artery (SCA) is a rare congenital anomaly in which the cardiac myocardium is supplied by a coronary circulation arising from a single ostium off of the aorta. SCAs are commonly classified according to the Lipton classification system, and the incidence appears to range between 0.014% and 0.066%.1Pourafkari L. Taban M. Ghaffari S. Anomalous origin of right coronary artery from distal left circumflex artery: a case study and a review of its clinical significance.J Cardiovasc Thorac Res. 2014; 6: 127-130PubMed Google Scholar,2Lipton M.J. Barry W.H. Obrez I. Silverman J.F. Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.Radiology. 1979; 130: 39-47Crossref PubMed Scopus (402) Google Scholar Presentations of patients with SCA include detection as an incidental finding on angiography, atypical chest pain, typical chest pain thought to be secondary to spasm or decreased blood flow, and typical chest pain with atherosclerosis requiring percutaneous intervention or bypass grafting.1Pourafkari L. Taban M. Ghaffari S. Anomalous origin of right coronary artery from distal left circumflex artery: a case study and a review of its clinical significance.J Cardiovasc Thorac Res. 2014; 6: 127-130PubMed Google Scholar,3Choi H.Y. Kim J.W. Moon J.M. et al.Unusual dominant course of left circumflex coronary artery to right coronary artery territory with absent right coronary artery.J Cardiol. 2010; 55: 117-119Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar,4Cuglan S. Cuglan B. The right coronary artery originating from the distal circumflex artery.J Clin Med Kazakhstan. 2020; 4: 47-50Crossref Google Scholar We report the case of a 62-year-old man with obstructive sleep apnea, obesity, and prediabetes (A1c: 6.3%) who was sent for evaluation of coronary disease, owing to a strong family history, after a stress echocardiogram showed antero-lateral ischemia. He had denied any cardiac symptoms, including angina, orthopnea, paroxysmal nocturnal dyspnea, and palpitations. Given the family history of sudden cardiac death and early coronary disease, he was sent for CT coronary angiography (CTCA), which showed a calcium score of 17 using the AJ 130 method (39th percentile for age, sex, and race), and no significant obstructive epicardial artery disease was seen. However, the CTCA demonstrated an SCA arising from the left coronary cusp, with the right coronary artery arising as a terminal extension of the circumflex artery in an L1 modified Lipton classification (Fig. 1A ). This finding was confirmed with conventional angiography showing the SCA and nonobstructive coronary disease (Fig. 1B). Reassuringly, his particular SCA demonstrated TIMI (from Thrombolysis in Myocardial Infarction) grade 3 flow and was not associated with other structural heart disease, as can sometimes be the case.4Cuglan S. Cuglan B. The right coronary artery originating from the distal circumflex artery.J Clin Med Kazakhstan. 2020; 4: 47-50Crossref Google Scholar In this case, we interpreted the echocardiogram as being a false-positive study, as there was no evidence of flow-limiting coronary disease, and so the patient was managed medically with blood pressure control, statin, and single antiplatelet therapy. Although angiography was performed because of a positive stress echocardiogram, CTCA is an ideal technique to characterize SCA anomalies and to noninvasively identify epicardial coronary anatomy in select patient populations.5Cademartiri F. La Grutta L. Malagò R. et al.Prevalence of anatomical variants and coronary anomalies in 543 consecutive patients studied with 64-slice CT coronary angiography.Eur Radiol. 2008; 18: 781-791Crossref PubMed Scopus (137) Google ScholarNovel Teaching Points•SCAs are rare congenital anomalies that are often incidentally diagnosed.•CTCA can provide anatomic detail and 3-dimensional orientation beyond that of conventional angiography.•CTCA can be useful in understanding complex congenital anomalies, including their anatomic relationship to nearby structures. •SCAs are rare congenital anomalies that are often incidentally diagnosed.•CTCA can provide anatomic detail and 3-dimensional orientation beyond that of conventional angiography.•CTCA can be useful in understanding complex congenital anomalies, including their anatomic relationship to nearby structures. The authors have no funding sources to declare.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».