Isolated Single Coronary Artery Presenting as Acute Coronary Syndrome: Case Report and Review

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

• References

• 1 Smith JC. Review of single coronary artery with report of 2 cases. Circulation 1950; 1 (5) 1168-1175
• 2 Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21 (1) 28-40
• 3 Butto F, Lucas Jr RV, Edwards JE. Persistent truncus arteriosus: pathologic anatomy in 54 cases. Pediatr Cardiol 1986; 7 (2) 95-101
• 4 Shrivastava S, Mohan JC, Mukhopadhyay S, Rajani M, Tandon R. Coronary artery anomalies in tetralogy of Fallot. Cardiovasc Intervent Radiol 1987; 10 (4) 215-218
• 5 Calder AL, Co EE, Sage MD. Coronary arterial abnormalities in pulmonary atresia with intact ventricular septum. Am J Cardiol 1987; 59 (5) 436-442
• 6 Desmet W, Vanhaeke J, Vrolix M , et al. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J 1992; 13: 1637-1640
• 7 Thebesius A. Dissertatio Medica de Circulo Sanguinis in Cordo. Ludg Batav, JA: Langerak; 1716
• 8 Halperin IC, Penny JL, Kennedy RJ. Single coronary artery. Antemortem diagnosis in a patient with congestive heart failure. Am J Cardiol 1967; 19 (3) 424-427
• 9 Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology 1979; 130 (1) 39-47
• 10 Longenecker CG, Reemtsma K, Creech Jr O. Surgical implication of a single coronary. A review and two case reports. Am Heart J 1961; 61: 382-386
• 11 Sharbaugh AH, White RS. Single coronary artery. Analysis of the anatomic variation, clinical importance, and report of five cases. JAMA 1974; 230 (2) 243-246
• 12 Kelley MJ, Wolfson S, Marshall R. Single coronary artery from the right sinus of Valsalva: angiography, anatomy, and clinical significance. AJR Am J Roentgenol 1977; 128 (2) 257-262
• 13 Kuon E, Ropers D. Single coronary artery—a rarity in the catheterization laboratory: case report and current review. Can J Cardiol 2004; 20 (6) 647-651