A PICTURE IS WORTH A THOUSAND WORDS Year : 2023  |  Volume : 24  |  Issue : 3  |  Page : 166-167  

Dual circumflex coronary arteries with direct origin of accessory circumflex from the left aortic sinus

Arun Sharma, Harsimran Bhatia, Manphool Singhal
Department of Radiodiagnosis, PGIMER, Chandigarh, India

Date of Submission08-Apr-2023Date of Acceptance05-Jun-2023Date of Web Publication05-Jul-2023

Correspondence Address:
Dr. Arun Sharma
Department of Radiodiagnosis, PGIMER, Chandigarh - 160 012
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/heartviews.heartviews_40_23

How to cite this article:
Sharma A, Bhatia H, Singhal M. Dual circumflex coronary arteries with direct origin of accessory circumflex from the left aortic sinus. Heart Views 2023;24:166-7
How to cite this URL:
Sharma A, Bhatia H, Singhal M. Dual circumflex coronary arteries with direct origin of accessory circumflex from the left aortic sinus. Heart Views [serial online] 2023 [cited 2023 Jul 6];24:166-7. Available from: https://www.heartviews.org/text.asp?2023/24/3/166/380493

Anomalies of the coronary artery origin are rare, with the majority of them being clinically silent. The most commonly reported anomaly with respect to the left circumflex artery (LCX) is its origin from the right aortic sinus or the right coronary artery with a retro-aortic course. Moreover, twin or dual circumflex arteries have also been reported originating from both the right and the left coronary artery systems, where the accessory LCX was seen originating from the right coronary artery or the right aortic sinus.[1],[2] More recently, the dual origin of the circumflex artery from the main stem of the left coronary artery has also been described. Dual circumflex coronary arteries with the accessory LCX arising from the left coronary sinus [Figure 1] and [Figure 2] are rare. Moreover, in the presence of a normal left main with its normal bifurcation pattern, as seen in the index case, such an anomaly may be missed on catheter angiography. Multi-detector computed tomography angiography allows more accurate delineation of the coronary artery ostium as well as its course and is being increasingly utilized in the diagnostic workup, considering its noninvasiveness, faster acquisition, excellent spatial resolution with multi-planar reconstruction capability.

Figure 1: Computed tomography angiography images (a and b) showing the normal origin of the right (RCA) and the left main (LM) coronary arteries with separate origin of the smaller accessory left circumflex (dashed arrow) from the left (L) aortic sinus, close to the origin of the LM. R: Right aortic sinus. RCA: Right coronary artery, LM: Left main, L: Left aortic sinus

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Figure 2: Volume-rendered computed tomography image showing dual circumflex coronary arteries with the direct origin of accessory circumflex (dashed arrow) from the left aortic sinus. LM: Left main, LAD: Left anterior descending, LCX: Left circumflex artery

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Declaration of patient consent

The authors certify that they have obtained all appropriate consent forms from the male patient. In the form the patient has given the consent for the images and other clinical information to be reported in the journal. The patient understands that the name and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
1.Coşansu K, Tarık Ağaç M, Kılıç H, Akdemir R, Gündüz H. Twin circumflex arteries: A rare coronary artery anomaly. J Tehran Heart Cent 2018;13:32-4.  
    2.Uğuz B, Tiryakioğlu SK, Öztaş S, Karakuş A. A very rare coronary artery anomaly: Twin circumflex arteries associated with acute coronary syndrome – Two cases report. Arch Clin Cases 2020;7:22-7.  
    
  [Figure 1], [Figure 2]