Anomalous Origin of Left Main Coronary Artery from the Right Sinus of Valsalva: A Case Series-based Review

Congenital anomalies involving the origin of coronary arteries are rare and the most common anomaly is left circumflex (LCX) arising from the right sinus of Valsalva (RSV). Other anomalies include a single coronary artery from the left sinus of Valsalva, both coronary arteries from RSV and left anterior descending coronary artery (LAD) from RSV. Anomalous origin of left main from RSV carries a high risk of sudden cardiac arrest. A retrospective analysis and literature review of three patients admitted to our medical center with the acute coronary syndrome, who underwent coronary angiography and were found to have left main coronary artery (LMCA) originating from the right coronary cusp (RCA). One patient had non-diseased coronaries with symptoms caused by the variant anatomy with possible compression of the LMCA, whereas the other two patients had 100% occluded RCA with variable stenosis in the left coronary system. Eventual surgical re-implantation with bypass grafting was required in all three patients. LMCA from the RSV is a rare, but often fatal anomaly. Due to a lack of data and inability to predict sudden cardiac death, the latest guidelines recommend surgical intervention (class 1 recommendation) for all patients with LMCA from RSV, regardless of ischemia or ischemic symptoms.