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All Journal Amerta Nutrition Jurnal Ilmu Kedokteran dan Kesehatan PREPOTIF : Jurnal Kesehatan Masyarakat Heart Science Journal Buletin Poltanesa
Saskia Dyah Handari
Universitas Ciputra Surabaya
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Isolated congenital absence of left circumflex mimicking single coronary artery: A rare coronary anomaly case report Ramadhan, Fitri Febrianti; Saskia Dyah Handari
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.13

Abstract

Background: Congenital coronary artery anomalies (CAAs) occur in roughly 1% of the population and, while often incidental, are recognized contributors to sudden cardiac death, particularly in younger individuals. Many anomalies remain silent until adulthood. Case Presentations: A 59-year-old man with obesity, hypertension, and heavy tobacco use presented with exertional dyspnea and recurrent chest pain radiating to the left arm and neck. Initial evaluation showed normal high-sensitivity troponin, an unremarkable electrocardiography (ECG), and a normal transthoracic echocardiogram; his clinical likelihood of obstructive coronary artery disease was estimated at Chronic Coronary Syndrome (CCS) Risk Factor-weighted Clinical Likelihood (RF-CL) 27%. Coronary CT angiography (CCTA) demonstrated congenital absence of the left circumflex artery (LCx) with a super-dominant right coronary artery (RCA) coursing subaortically to supply the lateral wall. A non-obstructive calcified plaque was identified in the proximal left anterior descending artery, with an Agatston calcium score of approximately 145, indicating quantifiable but moderate atherosclerotic burden. The distinction between a single coronary artery (SCA) and an absent LCx is clinically important. In SCA, all coronary branches originate from a single aortic ostium, whereas in absent LCx, there is no separate LCx ostium, and the RCA (and occasionally enlarged diagonal branches) perfuses the LCx territory; CCTA is pivotal for depicting ostial origin and vessel course. The patient was treated with a beta-blocker, an angiotensin-converting enzyme inhibitor, a statin, and aspirin. Conclusions: Given persistent symptoms, functional testing is recommended to determine ischemic significance and guide management. Accurate identification of this subtle anomaly and comprehensive risk stratification are essential to optimize outcomes. 
Co-Authors Adhitya Ginting Adnyani, Ida Ayu Tia Putri Agung, Purwakaning Purnomo Anjarwani, Setyasih Antonius Yansen Suryadarma Caesario, Fahreza Cholid Tri Tjahjono Cholid Tri Tjahjono Christine, Catarina Lilian Damayanti, Ni Nyoman Rere Dion, Aldy Djanggan Sargowo Elizabeth Sulastri Nugraheni Firdaus, Achmad Jauhar Fitri Febrianti Ramadhan, Fitri Febrianti Fransiska Anggreni Sihotang Galuh, Lukitasari Ayu Hanna Tabita Hasianna Silitonga Hargiyanto, Erlangga Diasmara Hebert Adrianto Imam Mi'raj Suprayoga Indra Prasetya Indrihapsari, Pratiwi Irwin Prijatna Kusumah Jefri, Wilhelmus Jennifer Tantadiputra Kahadi, Cik Martini, Heny Mellyanawati Mellyanawati Mirna Rahmasari Muhammad Firdaus Nidom, Astria Novitasari Novi Rahmawati Pratiwi, Irma Kamelia Putri, Firda Aulia Rafkha Hakam Irsyad Maulana Rahimah, Anna Fuji Ronald Torang Marsahala Panggabean Santosa, Rahajoe Imam Satrijo, Budi Sekarsari, Calysta Citra Sembiring, Yan Efrata Stefani Nurhadi Suprapta, Aloysius Yuwono Victor Kurniawan Yuwono Vori, Ira Yasa, Oka Suputra Yurike Dhika Adhela