Normal and anomalous coronary arteries: definitions and classification.

The conus artery has long been recognized as an important source of collateral blood supply to a significantly diseased left anterior descending artery. This artery which arises 50% of the time from a separate orifice in the right sinus of Valsalva may also provide collateral circulation to a diseased right coronary artery. To date, there have been no reported instances of the conus artery supplying collateral flow to a totally occluded circumflex artery. In this report we describe such a case in a patient with severe three vessel disease. The implications of such a finding in patient management are also discussed.

Total occlusion of the circumflex artery with collateral supply from the conus artery.

Total occlusion of the left main coronary artery (LM) is rare, with reported occurrence rates of 0.04 to 0.42% at coronary arteriography. 1–3 Patients with LM occlusion are of necessity dependent upon right coronary artery (RCA) collateral flow for survival. Although many of these patients have significant coronary artery disease involving the RCA, to our knowledge complete stenosis of the LM and RCA in a living patient has been previously reported only once. 3 At cardiac catheterization we noted complete proximal occlusion of the LM and RCA in a patient with who was dependent for myocardial blood flow on an aberrant vessel arising in the right coronary cusp or from the very proximal RCA.

Total proximal left main and right coronary artery occlusion with survival

Aberrant origin of coronary arteries is a not uncommon entity found on cardiac catheterization, at the time of surgery, and on post mortem examination. We present two cases of origin of a right ventricular (or atypical large conus) branch of the right coronary artery originating from a separate ostium in the right coronary cusp, which to our knowledge has been only rarely previously described. We feel that this may be a relatively frequent coronary varient that has important implications regarding patient assessment and care.

Aberrant origin of the right ventricular coronary artery: a report of two cases.

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Aberrant origin of the right ventricular coronary artery: a report of two cases.