Case Report

Congenital Absence of Left Circumflex Artery: A Case Report and Review of the Literature

Table 1

Cases of patients presenting with congenitally absent left circumflex artery.

RefAgesexComorbiditiesChest painDiagnostic procedureMIEcho/nuclearAssociated anomalies of other vessels

Ali et al. [4]40MDM, HTN, smokingExertional pain CPCATHYesReduced LV function, with inferior and posterior segments were akinetic, anterior, lateral, and septal segments hypokinesisLarge RCA (70% stenosis) and complete occlusion of LAD → CABG, super dominant RCA

Ali et al. [4]39MNoneExertional pain CPCATHNoNASuperdominant RCA

Varela et al. [3]55FNoneNonexertional CPCATHNoNASuperdominant RCA

Oliveira et al. [5]70MAortic stenosisExertional chest pain, syncopeCATHNoHFPEF 58%, severe AS area < 0.7Superdominant RCA, anomalous origin of left coronary artery from right coronary sinus

Duan et al. [6]66MConstrictive pericarditisNoneCATH (Pre-op evaluationNoNASuperdominant RCA and enlarged LAD branches

Guo and Xu [7]52MHTN, smokingNonexertional CPCATH + CTYesEcho showed severe hypokinesis of the lateral wall, inferior left ventricular wall thinning and akinesisSuperdominant RCA + RCA thrombus, mid portion of LAD stenosis

Quijada-Fumero et al. [8]51MDM, HTN, obesityNone (T wave inversions in V3-v6)CATHNoNormal LV, no RWMANormal LAD, absent LCX, superdominant RCA

Lin et al. [9]44FNoneExertional CPCATHNoThallium perfusion showed perfusion defects in the septal and inferior walls which normalized in the delayed imagingSuperdominant RCA coronary angiogram

Teunissen et al. [10]46MNoneExertional CPCATHNoNormal LV, no RWMAMid segment of LAD was atretic originating from left sinus Valsalva, superdominant right coronary artery

Vijayvergiya and Jaswal [11]40MNoneNonexertional CPCATHNoNormal LV, no RWMASuperdominant RCA, LAD originated from the right coronary cusps

Hongsakul and Suwannanon [12]52MHTN, smokingExertional CPCTStress test, inconclusiveSuperdominant RCA

Majid et al. [13]55FHTNNonexertional CPCTNoNASuperdominant RCA

Hong et al. [14]68MHLDNonexertional CPCATH then CTYesNASuperdominant RCA, with acute thrombosis of RCA

Bildirici et al. [15]67FHTNExertional CPCATH, Confirmed with aortographyNoNormal EF (NRWMA)Dual LAD, superdominant RCA

Yoon et al. [16]48MHTN, chronic alcoholismNonexertional CPCATHNoLVH with no other abnormalitySuperdominant RCA

Baskurt et al. [17]55FNoneNonexertional CPCATH, Confirmed with aortography and MDCT (multidetector row Computed tomography)NoNormal LV, no RWMASuperdominant RCA

Sato et al. [18]62MCADExertional CPCoronary CT/CATHNoNASuperdominant RCA

Harada et al. [19]65FAortic stenosisNoneCT coronary (Pre-op)NoNAAbsence of left circumflex and left subclavian

Doven et al. [20]67MHTN, HLD, smokingExertional CPCATHNoNormal EF, no RWMASuperdominant RCA

Harada et al. [19]49MHTN, HLDExertional CPCATHYesNAComplete Left main occlusion, absent LCX → treated with PCI

Our case46MNoneNone (frequent PVCs and abnormal Echo findings)CATHNoEcho-EF of 40–45%, with mild diffuse hypokinesis with RWMA and akinesis in the basal-mid inferior wallsSuperdominant RCA

CATH: coronary angiogram, EF: left ventricular ejection fraction, F: female, HTN: hypertension, LAD: left anterior descending artery, LCX: left circumflex artery, HTN: hypertension, M: male, NA: not available, RCA, right coronary artery, RWMA, regional wall motion abnormalities, STEMI: ST segment elevation MI, and CP: chest pain.