A Hidden Connection: Anomalous Left Circumflex Artery Arising From the Right Pulmonary Artery Unveiled by Cardiovascular Computed Tomography

Introduction

Congenital coronary artery anomalies are uncommon but clinically significant conditions that may present across a broad spectrum, ranging from incidental findings to myocardial ischemia, ventricular arrhythmias, heart failure (HF), and sudden cardiac death (SCD). In adults, anomalous coronary origins may be particularly challenging to recognize because symptoms are often nonspecific and may overlap with more prevalent causes of chest pain, dyspnea, or palpitations.

In rare cases, a coronary artery may originate from the pulmonary arterial circulation, resulting in myocardial perfusion that depends on collateral flow from the remaining coronary arteries arising from the aorta, thereby predisposing the myocardium to ischemia-related electrical instability. Noninvasive anatomical imaging plays a pivotal role in establishing a definitive diagnosis, particularly when conventional angiography is inconclusive.

[…]