The Anatomical History of a Single Coronary Artery Anomaly: A Case Report

Single coronary artery(SCA) anomaly is a rare anomaly where the right and left coronary arteries arise from a single ostium in the sinus valsalva and feed the whole heart. Although asymptomatic in most cases, it can cause angina, syncope, myocardial infarction and sudden cardiac death. It is essential to diagnose it especially in terms of the risk of encountering clinical pictures such as sudden death at a young age and its association with other congenital anomalies. In this report, we present a patient with a SCA anomaly. During an emergency conventional angiography, a right coronary artery(RCA) arising from the left main coronary artery(LMCA) originating from a single ostium was detected in the aorta.

Case report: echocardiographic detection of rare single coronary artery anomaly in a child with an atrial septal defect

Background A single right coronary artery (RCA) with the left anterior descending (LAD) and circumflex coronary arteries located in the usual anatomic position and supplied by collaterals is the rarest variant of single RCA. Case summary We report a paediatric patient with an incidental finding of single RCA Lipton type RI pattern during assessment for transcatheter device closure of an ostium secundum atrial septal defect (secASD). Transthoracic echocardiography (TTE) revealed a dilated RCA, abnormal flow in the LAD, and no identifiable left main coronary artery. Diagnosis of a single RCA was confirmed with angiography. Dobutamine stress echocardiography revealed no inducible ischaemia. Transcatheter device closure of the secASD was subsequently successfully performed. Discussion TTE in paediatric patients can raise suspicion of coronary artery origin anomalies. Additional modalities, such as computed tomography and angiography, are required to comprehensively determine coronary artery anatomy. Functional assessment of ventricular function is also indicated. Coronary artery anatomy is important to delineate prior to transcatheter device closure of a secASD and should be part of the pre-procedure assessment.

Single Coronary Artery Anomaly as a Different Ethiological Variant of Myocardial Ischemia

The single coronary artery is а rare congenital disorder, a subset of coronary artery anomalies. The clinical presentation varies from asymptomatic to malignant variants and is usually diagnosed during coronary angiography or post-mortem examinations. It may or may not be associated with another congenital heart disease. During the three years period and based on clinical indications, we performed selective coronary angiography of 7,996 patients. We discovered five clinical cases of a single coronary artery, which complies with the frequency of this anomaly 0.06% of the study population. All five clinical cases had moderate left ventricular systolic dysfunction and four of them had sinus rhythm disturbances – supraventricular cardiac arrhythmias or sinus tachycardia. Anomalous coronary anatomy may result in insufficient flow delivery even without coronary obstruction. It is important to specify the course of the ectopic artery. Cardiac ischemia could explain left ventricular systolic dysfunction and rhythm disorders. Significant coronary artery disease had three of them. The main goals of this research are to detect the frequency of single coronary artery anomaly among studied population, to illustrate the variety of clinical presentation of this disorder, related to anatomical variants of the anomaly, and to choose the most appropriate treatment decision, based on the present experience.