Responsibility Comes with the Dominance: A Rare Case Report of Absent Right Coronary Artery with Super Dominant Left Circumflex Artery

Coronary artery dominance describes the source from which the Posterior Descending Artery (PDA) is arising that supplies the inferior wall. 80-85% of the times it is Right Coronary Artery (RCA) referring to right dominance, 7-13% of the times it is Left Circumflex artery (LCx) referring to left dominance and about 2-5% of the times it is originating from both the RCA and LCx making a codominant supply. A super dominant vessel is when a vessel is exceptionally huge supplying the area that the other vessel usually covers which makes cardiac circulation rely on one vessel. Here we present a rare case of absent RCA with super dominant LCx supplying the RCA territory diagnosed through Coronary Computed Tomography Angiography (CCTA). As invasive coronary angiography may not always provide sufficient information in such cases, CCTA is considered as a robust, reliable and non-invasive modality of imaging to investigate so as to avoid an ischemic insult.