Anomalous Right Coronary Artery Arising From Distal Left Circumflex Artery
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".