[Anomalous origin of the left anterior descending artery from the right coronary artery: A case report].

BACKGROUND

Congenital coronary anomalies represent a heterogeneous spectrum of anatomical variants that may predispose to myocardial ischemia, arrhythmias, and sudden cardiac death, particularly when the vessel follows an interarterial course. Although their prevalence is low, timely recognition is essential to prevent unnecessary interventions and guide appropriate treatment. The objective was to describe a case of anomalous origin of the left anterior descending (LAD) artery from the right coronary artery, highlighting the role of multimodality imaging in anatomical characterization and therapeutic decision-making.

CASE REPORT: A 66-year-old woman with hypertension, type 2 diabetes, and dyslipidemia presented with severe oppressive chest pain in the context of a non-ST-segment elevation myocardial infarction. Initial coronary angiography suggested chronic LAD occlusion with heterocoronary circulation from the right coronary artery. An attempted percutaneous coronary intervention was unsuccessful. Reevaluation with coronary CT angiography revealed an anomalous LAD origin from the right coronary artery, in addition to a hypoplastic native LAD arising from the left main coronary trunk, findings that explained the initial diagnostic discordance.

CONCLUSIONS

Early recognition of rare coronary variants through multimodality imaging allows for tailored diagnostic and therapeutic strategies, since it prevents unnecessary procedures, enhances patient safety, and supports individualized management based on vessel course and hemodynamic significance.