Can Transthoracic Echocardiography Predict Anomalous Origin of the Left Circumflex Coronary Artery in Adults? A Case Report
Anomalous origin of LCX
DOI:
https://doi.org/10.3329/bmrcb.v51i02.82376Keywords:
Anomalous origin of left circumflex artery (LCX), crossed aorta sign, retro aortic anomalous coronary (RAC)Abstract
Congenital coronary artery anomaly (CAA) is a rare entity. Recognition and precise detection of the CAA is essential for correct management of the condition. Various diagnostic techniques can be used to detect CAA and to assess the presence of high-risk features associated with CAA. Coronary computed tomography angiography (CCTA) is currently considered the gold standard test for diagnosing CAA and cardiac magnetic resonance (CMR) is considered as an alternative but both the techniques are expensive and not widely available in every corner of our country. Transthoracic echocardiography (TTE) is regarded as a key tool in the detection & diagnostic workup of CAAs in children, in whom the optimal acoustic windows usually allow the visualization of coronary ostia and there is no risk of radiation exposure. In adults, TTE plays a minor role in detecting CAA because here TTE can’t identify coronary ostia clearly. Moreover, in adults it is difficult to visualize the course of coronary artery & it’s relations with the great vessels by TTE. In spite of all limitations; in some adult cases, identification of two signs in TTE can predict anomalous origin of coronary artery (AOCA). These two signs are “RAC sign” (retro aortic anomalous coronary) and “Crossed aorta sign”. Therefore, visualization of RAC sign & /or “Crossed aorta sign” in TTE can predict the presence of anomalous origin of left circumflex coronary artery (LCX). In this middle-aged woman while performing TTE, we found these two signs (RAC sign & Crossed aorta sign) and predicted her to have anomalous origin of LCX. Subsequently coronary angiogram (CAG) confirmed the diagnosis. So, careful echocardiographic observation may alert the interventional cardiologist to pay special attention during coronary catheterization to find out AOCA.
Bangladesh Medical Res Counc Bull 2025;51(2): 103-106
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Copyright (c) 2025 Abdul Wadud Chowdhury, Gobinda Kanti Paul, A K M Monwarul Islam, Kaniz Fatema Ananya
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