Document Type : Case Report


Department of Cardiology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey


Introduction: Coronary artery anomalies are rare clinical entities reported in 0.6% to 5.6% of diagnostic coronary angiographies. Anomalous origins of coronary arteries from distal segments are rarely reported. Presented herein is a coronary anomaly in which the circumflex artery (CX) originated as a continuation of the posterolateral branch of the right coronary artery (RCA) with separate left anterior descending (LAD) artery origination from the left sinus of Valsalva. The clinical presentation of such a rare anomaly is discussed, and the current literature regarding the congenital absence of CX is reviewed.
Case Presentation: A 66-year-old male presented with angina pectoris. Coronary angiography revealed critical stenosis in the mid segment of the LAD artery and an anomalous origin of CX artery from the distal RCA. The CX was coursing as a continuation of the posterolateral branch of the RCA. Coronary angioplasty and stent deployment was performed for the LAD lesion, and the patient was discharged with medical therapy. The patient did not report recurrent anginal symptoms under medical therapy.
Conclusion: The congenital absence of the circumflex coronary artery is a rare coronary anomaly. The clinical presentation may vary, though most cases are asymptomatic during diagnosis. Such cases require close clinical follow-up since they entertain a future risk for being symptomatic, especially in the setting of atherosclerotic disease.


  1. Yurtdaş M, Gülen O. Anomalous origin of the right coronary artery from the left anterior descending artery: review of the literature. Cardiol J. 2012;19(2):122-129. doi:10.5603/CJ.2012.0023.
  2. Prashanth P, Mukhaini M. Single right coronary artery continuing as left circumflex artery and hypoplastic left anterior descending artery: a rare coronary anomaly. J Invasive Cardiol. 2008;20(6):E192-E194.
  3. Subban V, Victor SM, Ajit MS, Kalidoss L. Single coronary artery from the right coronary sinus with proximal origin of the left anterior descending coronary artery and left circumflex as distal continuation of the right coronary artery: a rare variant. Cardiovasc J Afr. 2012;23(8):e13-e14. doi: 10.5830/CVJA-2012-034.
  4. Arslan U, Karamanlıoğlu M, Korkmaz A. Conventional and computed tomography angiography views of a rare type of single coronary artery anomaly: right coronary artery arising from distal left circumflex artery. Anadolu Kardiyol Derg. 2012;12(6):522-523. doi: 10.5152/akd.2012.164.
  5. Chung SK, Lee SJ, Park SH, Lee SW, Shin WY, Jin DK. An extremely rare variety of anomalous coronary artery: right coronary artery originating from the distal left circumflex artery. Korean Circ J. 2010;40(9):465-7. doi: 10.4070/kcj.2010.40.9.465.
  6. Ullah S, Khan M, Khan NAJ, Zeb H, Patel R. Absence of left circumflex artery: a rare congenital disorder of coronary arteries. Case Rep Cardiol. 2017;2017:8710135. doi: 10.1155/2017/8710135.
  7. Guo J, Xu M. Congenital absence of the left circumflex artery associated with inferior myocardial infarction. Intern Med. 2012;51(1):71-74. doi: 10.2169/internalmedicine.51.6141.
  8. Hong PS, Lee YS, Lee JB. Congenital absence of the left circumflex coronary artery in a patient with acute inferior myocardial infarction. Herz. 2014;39(8):957-959. doi:10.1007/s00059-013-3893-0.
  9. Amoroso G, Monni E, Limbruno U, et al. Primary angioplasty for acute myocardial infarction in a patient with a solitarycoronary ostium and a “superdominant” right coronary artery. Int J Cardiol. 2005;99(3):473-476. doi:10.1016/j.ijcard.2003.11.056.
  10. Kus O, Acar B, Selcuk H, Selcuk MT. Absence of the right coronary artery with distal angulation of the left circumflexcoronary artery. Herz. 2015;40(2):332-334. doi: 10.1007/s00059-013-4007-8.