Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2019; 7(5): 628-635
Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.628
Diagnostic detection with cardiac tomography and resonance of extremely rare coronary anomaly: A case report and review of literature
Nicolò Schicchi, Marco Fogante, Gian Marco Giuseppetti, Andrea Giovagnoni
Nicolò Schicchi, Gian Marco Giuseppetti, Andrea Giovagnoni, Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
Marco Fogante, Department of Radiology, Università Politecnica delle Marche, Ancona 60126, Italy
Author contributions: Schicchi N interpreted the imaging and contributed to manuscript drafting; Fogante M reviewed the literature and contributed to manuscript drafting; Giuseppetti GM and Giovagnoni A were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient’s parents for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marco Fogante, MD, Research Scientist, Radiologist, Department of Radiology, Università Politecnica delle Marche, Via Tronto 10, Ancona 60126, Italy. m.fogante@pm.univpm.it
Telephone: +39-33-38949603
Received: December 24, 2018
Peer-review started: December 25, 2018
First decision: December 29, 2018
Revised: January 9, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: March 6, 2019
Abstract
BACKGROUND

The association of two congenital coronary artery anomalies (CAAs) is extremely rare but represents one of the main cause of sudden cardiac death in young athletes. Although coronary angiography (CX-A) is still widely used in childhood, cardiac magnetic resonance (C-MRI) and cardiac computed tomography (C-CT) have recently taken on an increasing diagnostic role in early detection of CAAs and concomitant congenital cardiac malformations.

CASE SUMMARY

A healthy 10-year-old male patient was referred to the Radiological Department of our Institution due to no evidence of left coronary artery in echocardiographic examination. With C-MRI was detected marked myocardial trabeculation and was suspected anomalous origin and course of left circumflex (LCx) artery and of left anterior descending (LAD) artery. With third generation Dual Source C-CT 192x2-sections (SOMATOM Force, Siemens, Germany) was confirmed anomalous origin of LCx artery from right pulmonary artery associated with anomalous origin of LAD artery from right coronary artery with course in front of right ventricular outflow tract. The patient underwent surgical treatment with reimplantation of the anomalous LCX and LAD arteries into the wall of ascending aorta, with no postoperative complications. The patient remained asymptomatic and follow-up C-MRI scan four months after operation showed complete success of surgery treatment.

CONCLUSION

This case highlights the diagnostic potential of C-CT and C-MRI in evaluation of CAAs and of cardiac morphology and functionality, with very low radiation dose and without the risks related to invasive procedure.

Keywords: Coronary anomalies, Cardiac computed tomography, Cardiac magnetic resonance, Case report, Coronary artery anomalies

Core tip: Congenital coronary artery anomalies (CAAs) represent one of the main causes of sudden cardiac death in young athletes. For this reason, early detection of CAAs is essential. We present an extremely rare case of association of two congenital coronary anomalies, characterized by anomalous origin of left circumflex artery from right pulmonary artery and anomalous origin of left anterior descending artery from right coronary artery with course in front of right ventricular outflow tract. This case highlights the diagnostic potential of cardiac computed tomography and cardiac magnetic resonance in evaluation of CAAs and of cardiac morphology and functionality, with very low radiation dose and without the risks related to invasive procedure.