BMJ Case Reports 2017; doi:10.1136/bcr-2017-219265

Incidental finding of anomalous circumflex coronary artery from right coronary sinus prior to aortic valve surgery

  1. Rakesh Uppal1
  1. 1Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK
  2. 2Department of Cardiovascular Surgery, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany
  3. 3University of Liverpool School of Medicine, Liverpool, UK
  1. Correspondence to Amer Harky, aaharky{at}
  • Accepted 13 March 2017
  • Published 31 March 2017


Anomalous origin of the left circumflex (Cx) artery is a common and mostly benign coronary artery anomaly. We report the case of a man aged 52 years who presented to his local hospital with progressive breathlessness on exertion and syncopal episodes. His admission transthoracic echocardiography (TTE) showed bicuspid aortic valve, severe aortic stenosis with a valve area of 0.5 cm2 and his left ventricular ejection fraction (LVEF) was 27%. His coronary angiogram showed normal coronary arteries but anomalous origin of the Cx artery from the right coronary. He underwent elective bioprosthetic aortic valve replacement. His postoperative recovery was uneventful and he was discharged on day 5 postoperatively. His TTE postoperatively showed well-seated aortic valve, improved LVEF to 51%. We here report a case of incidental finding of anomalous Cx artery arising from the right coronary while the patient is being worked up for aortic valve replacement for congenital bicuspid aortic valve.


  • Contributors AHo and MUA have drafted the case report, AHa supervised the writing, reviewed and amended accordingly. RU is the responsible cardiac surgeon who operated on the patient.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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