Cor Vasa 2022, 64(4):457-462 | DOI: 10.33678/cor.2021.096

Anomalous Coronary Artery Presented with Typical Chest Pain: What is Define The Malignant from Benign Anomalous Coronary Artery (A Case Series)

Louisa Fadjri Kusuma Wardhani^{a, b}, Ivana Purnama Dewi^{a, b, c}, Arifta Devi Anggraeni^{a, b, d}, Meity Ardiana^{a, b}

^a Faculty of Medicine, Airlangga University, Surabaya, Indonesia

^b Department of Cardiology and Vascular Medicine, Dr Soetomo General Hospital Surabaya, Indonesia

^c Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia

^d Gambiran General Hospital, Kediri, Indonesia

Background: Congenital coronary anomalies (CCA) are the important causes of morbidity and mortality associated with angina or SCD. CCA divided into two groups, depending on the origin and course of the coronary artery. Malignant CCA comprises arteries with ectopic origin from the contralateral side of the heart followed by an inter-arterial course. Case summary: We presented two distinct characteristics of coronary anomalies with typical chest pain presentation. Both patients had a normal physical examination and no ischemia sign. Coronary CT-angiography showed a malignant type of right anomalous coronary artery from the opposite sinus (R-ACAOS) with an inter-arterial course in case 1. A napkin-ring sign mixed plaque single vessel disease following benign type LCx originating from right coronary sinus anomaly found in case 2. Both patients have different mechanisms causing angina presentation, but both are at high risk of fatal cardiac events. A higher acute coronary syndrome risk and sudden cardiac death were found in patients with the napkin-ring sign, which in case 2 were possibly caused by acute take-off angle features. These supported the term "malignant" caused by inter-arterial course features but followed by several other features.

Conclusions: ACAOS is a rare congenital abnormality and not clinically significant, but some have potentially severe symptoms. From the case presented, we could learn that some abnormalities could redefine the terms malignantly even in the so-called benign ACAOS. Surgery could be performed besides OMT in reducing the risk of fatal cardiac events and SCD.

Keywords: Anomalous coronary artery, Benign ACAOS, Congenital coronary anomalies, Inter-arterial course, Malignant ACAOS, Malignant anomalous coronary artery arising from opposite sinus

Received: June 1, 2021; Revised: August 3, 2021; Accepted: August 6, 2021; Published: September 1, 2022  Show citation