Abstract
Congenital single coronary artery is commonly associated with complex congenital heart
diseases and manifests in infancy or childhood. But isolated single coronary artery
is a rare congenital anomaly which can present as acute coronary syndrome in adults.
The aim of the work is to discuss on isolated single coronary artery in two adults
presenting as acute coronary syndrome. The first case underwent coronary angiography
(CAG) through right radial route, but switched over to femoral for confirmation of
diagnosis and due to radial spasm. An aortic root angiogram was done to rule out presence
of any other coronary ostia. It revealed a single coronary artery originating from
right sinus of valsalva. After giving rise to posterior descending artery branch at
crux, it continued in the atrioventricular groove to the anterior basal surface of
the heart and traversed as anterior descending artery. There was no atheromatous occlusive
stenosis. This is R-I type single coronary artery as per Lipton classification. In
the second case, angiography was completed through right radial route. It revealed
a single coronary artery arising from right aortic sinus. Anterior descending and
circumflex branch were originating from proximal common trunk of the single coronary
artery and supplying the left side of the heart. The right coronary artery has diffuse
atheromatous disease without significant stenosis in any major branch. This is R-III
C type as per Lipton classification. A coronary anomaly of both origin and course
is very rare. It may be encountered in adults evaluated for atherosclerotic coronary
heart disease. Knowledge and understanding of anatomical types of this congenital
anomaly will reduce time, anxiety, complications during CAG and cardiac surgery.
Keywords
single coronary artery - coronary angiography - multi-slice computerized tomography
coronary angiography - Lipton classification
