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Complex Congenital Coronary Artery Malformations: A Case Report

Mei-lian Cai*, Wei Zhang

Background: Congenital type R-I Left Coronary Artery (LCA) absence, combined with Myocardial Bridge (MB) over the right coronary artery, is a rare congenital coronary artery malformation, and may have fatal consequences.

Patient: A 52-year-old man presented with chest pain for 3 days and 2 hours. The patient was advised for admission. He underwent Computed Tomography Angiography (CTA) examination of the coronary artery to screen for Coronary Artery Disease (CAD).

Results: The coronary artery CTA showed the absence of LCA and the MB was confined to the second right ventricular branch. Coronary Angiography (CAG) examination confirmed congenital absence of LCA combined with MB over the right coronary artery and 20% stenosis in the right coronary artery. Treatment was given according to the secondary prevention of Coronary Heart Disease (CHD). After 3 days of treatment, the symptoms of chest pain did not recur, and the Electrocardiogram (ECG) was normal.

Conclusion: If the patient has ischemia changes in ECG but no detectable changes in myocardial enzymes, myoglobin and serum troponin T, a coronary artery Computed Tomography Angiography (CTA) examination can be utilized to screen for single coronary malformations and other varieties of cardiovascular malformation. CAG can be performed to confirm the diagnosis.