**6.3 Case 3**

The third case is 64-year-old man hospitalized to our clinic due to of chest pain. Also, patient was a smoker and had a history of arterial hypertension, obesity, and dyslipidemia. Biochemical parameters were: serum creatinine kinase (CK) level of 82 IU/L, creatinine kinase-myocardial band (CK-MB) level of 6.5 ng/mL, and troponin-I level of 0.1 ng/mL. Electrocardiography (ECG) is characterized with deep Q wave in inferior and V4–V6 leads with biphasic T in inferior and V3–V6 leads. In transthoracic echocardiography (TTE) is presented with regional motion abnormalities in the entire severely hypokinetic inferoposterio wall.

The patients underwent coronary angiography that revealed the LCx arising from the right coronary sinus (**Figure 9**). The mildly stenosed LCx coexists with a stenosed RCA.

#### **6.4 Case 4**

The second case is 67-year-old man presented to the emergency department with chest pain that had developed 6 h previously. That patient had a history of arterial hypertension for 10 years, diabetes mellitus type 2, and chronically hemodialyzed for 7 years. The laboratory findings showed a serum creatinine kinase (CK) level of 473 IU/L, creatinine kinase-myocardial band (CK-MB) level of 6.4 ng/mL,

**Figure 6.** *Right coronary artery.*

#### **Figure 7.**

*Right coronary artery rising from left Valsalva sinus from a separate ostia with the left coronary artery.*

#### **Figure 8.** *Tortuous medial and distal segments of LAD.*

and troponin-I level of 0.15 ng/mL. Electrocardiography demonstrated ST segment depression of 1–2 mm in leads V4–V6, and inverted T wave in D2, D3, aVF. The transthoracic echocardiography (TTE) revealed severely hypokinetic medioapical

**117**

septum and inferior wall.

*Revealed a LCx as a proximal branch of RCA.*

the method of the treatment.

**7. Comments**

**Figure 10.**

**Figure 9.**

*Anomalous Origin of Coronary Arteries DOI: http://dx.doi.org/10.5772/intechopen.76912*

*Revealed LCx arising from right coronary sinus.*

segments of anterolateral wall, and hypokinetic basal segments of interventricular

The coronary angiography of patients with coronary ischemia determined atherosclerotic disease with possibility of the presence of coronary artery anomalies, but also coronary angiography may reveal coronary artery anomaly without the presence of atherosclerotic changes. The ectopic origin from opposite sinus of coronary artery anomalies that presents with atherosclerotic changes continues to

The atherosclerotic coronary artery disease leads to the need of coronarography which can find out the presence of coronary artery anomalies. We should think about these anomalies during coronarography knowing that based on type of these anomalies and considering the vulnerability to atherosclerosis will be determined

lesion up to 80%. The LCx and RCA are occluded in medial segment.

exist as a challenge during treatment in interventional cardiology.

The coronary angiography revealed a left circumflex artery (LCx) as a proximal branch of the right coronary artery (**Figure 10**). The LAD contained an proximal

*Anomalous Origin of Coronary Arteries DOI: http://dx.doi.org/10.5772/intechopen.76912*

*Vascular Biology - Selection of Mechanisms and Clinical Applications*

and troponin-I level of 0.15 ng/mL. Electrocardiography demonstrated ST segment depression of 1–2 mm in leads V4–V6, and inverted T wave in D2, D3, aVF. The transthoracic echocardiography (TTE) revealed severely hypokinetic medioapical

*Right coronary artery rising from left Valsalva sinus from a separate ostia with the left coronary artery.*

**116**

**Figure 8.**

*Tortuous medial and distal segments of LAD.*

**Figure 6.**

**Figure 7.**

*Right coronary artery.*

**Figure 9.** *Revealed LCx arising from right coronary sinus.*

**Figure 10.** *Revealed a LCx as a proximal branch of RCA.*

segments of anterolateral wall, and hypokinetic basal segments of interventricular septum and inferior wall.

The coronary angiography revealed a left circumflex artery (LCx) as a proximal branch of the right coronary artery (**Figure 10**). The LAD contained an proximal lesion up to 80%. The LCx and RCA are occluded in medial segment.
