Case report: intravascular ultrasound-guided entry to an anomalous highly angulated circumflex coronary artery originating from the right sinus of Valsalva

Abstract

Abstract Background Anomalous coronary arteries originating from the contralateral sinus of Valsalva constitute a rare congenital anomaly. Most of such anomalous coronary arteries exhibit slit-like orifice that are often compounded by external compressive factors. Consequently, percutaneous coronary intervention (PCI) of these vessels poses considerable challenges, both in terms of cannulation but also intervention in often acutely angulated vessels. Case summary A 61-year-old man, with a history of previous coronary artery bypass graft surgery and PCI presented with a history consistent with unstable angina. Notably, the left circumflex artery (LCX) in this individual exhibited an anomalous origin. Due to unfavourable anatomy and ambiguous LCX ostium take-off, previous operators had elected PCI of the saphenous vein graft (SVG) anastomosed to the obtuse marginal branch. A computed tomography scan on this occasion confirmed occlusion of the SVG and defined precise origin of anomalous coronary artery. Real-time live intravascular ultrasound (IVUS) positioned in the ascending aorta, in the right sinus of Valsalva, allowed visualization of the origin and wiring of the anomalous circumflex coronary artery and also facilitated successful PCI. Discussion As far as we are aware, this is the first description of IVUS assisted wiring of an anomalous coronary artery. Intravascular ultrasound also facilitated decision making in this complex angioplasty of an angulated and heavily diseased circumflex coronary artery.