PMC6159140_01
ECG upon presentation to the emergency room showing RBBB and ST segment elevation in leads II, III and AVF.
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ST segment elevation in leads II, III and AVF (Figure 1). She underwent emergent coronary angiography which showed normal coronary arteries but with aberrant take-off of the right coronary artery (RCA) from the mid-segment of the left anterior descending (LAD) artery (Figure 2).
(a) AP cranial view of the left coronary system showing the left main coronary artery, LAD (large arrow), circumflex (arrow head), and the RCA with its aberrant take-off from the mid-LAD segment (small arrow). (b) Right anterior oblique view showing the proximal LAD (black arrow head), distal LAD (white arrow head) and the aberrant RCA taking off from the mid-LAD with its distal branches (small arrow). LAD, left anterior descending; RCA, right coronary artery.
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ST segment elevation in leads II, III and AVF (Figure 1). She underwent emergent coronary angiography which showed normal coronary arteries but with aberrant take-off of the right coronary artery (RCA) from the mid-segment of the left anterior descending (LAD) artery (Figure 2).
Cardiac CT image showing the left coronary artery and the aberrant RCA (small arrow) with its take-off from the mid-segment of the LAD. LAD, left anterior descending; RCA, right coronary artery.
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A cardiac CT angiogram (Figure 3) was subsequently performed and it showed an aberrant origin of the RCA from the lateral aspect of the mid-segment of the LAD.
image (a) demonstrates the classical IB1 type of Shirani and Roberts classification where the RCA originates from the distal segment of the left main coronary artery, whereas, image (b) demonstrates the origin of the RCA at the mid-segment of the LAD. LAD, left anterior descending; RCA, right coronary artery.
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This rare variant has not been categorized in the classification of coronary anomalies; however, it closely resembles the IB1 type of Shirani and Roberts's classification with the only exception of the RCA origin at the mid-segment and not the proximal segment of the LAD (Figure 4).