JACC Case Rep. 2026 Jul 10:109300. doi: 10.1016/j.jaccas.2026.109300. Online ahead of print.
ABSTRACT
BACKGROUND: An anomalous right coronary artery (RCA) from the left anterior descending artery (LAD) is rare.
CASE SUMMARY: A 63-year-old man with exertional epigastric discomfort had an RCA from the mid-LAD, severe proximal LAD stenosis upstream from the anomalous takeoff, LAD-RCA bifurcation disease, and obtuse marginal disease. The heart team selected coronary artery bypass grafting (CABG) to avoid shared-inflow jeopardy and achieve complete revascularization. Grafting used left internal mammary artery-LAD, sequential saphenous vein graft-diagonal branch-first obtuse marginal, and saphenous vein graft-anomalous RCA; recovery was uncomplicated.
DISCUSSION: Severe proximal LAD stenosis can threaten both LAD and RCA territories in this anatomy. Multimodality imaging guided individualized CABG.
TAKE-HOME MESSAGES: Proximal LAD stenosis in anomalous RCA-from-LAD anatomy can create shared LAD-RCA inflow risk. Coronary computed tomographic angiography and angiography define the anomalous course and procedural hazards; CABG can restore independent inflow in complex multivessel disease.
PMID:42446451 | DOI:10.1016/j.jaccas.2026.109300