A Case Report: Rare Anomaly of a Single Coronary Artery Arising from the Right Aortic Sinus of Valsalva
DOI:
https://doi.org/10.38179/ijcr.v1i1.18Keywords:
Single coronary artery, congenital heart disease, left circumflex artery, left anterior descending artery, right ostium, chest pain, case reportAbstract
Background: Single Coronary Artery (SCA) is a rare, most commonly asymptomatic, congenital anomaly which is usually discovered incidentally during investigations. This entity consists of a single coronary artery supplying the entire myocardium. It may be classified based on the origin and the course of the artery. Depending on the patient's presentation and its severity, medical or invasive interventions may be warranted.
Case Report: A 65-year-old female patient known to have diabetes and hypertension presented to our emergency department with chest pain and discomfort. Blood tests and electrocardiography (ECG) showed no significant abnormalities, but on coronary angiography, we suspected an anatomical variation. Computed tomography angiography (CTA) confirmed our suspicion revealing a single coronary artery supplying the entire myocardium and arising from the right sinus of Valsalva. The patient received medical therapy and was discharged home.
Conclusion: We presented this case of Single Coronary Artery due to the rarity of this diagnosis. Presentation, treatment plan, and prognosis typically vary depending on the subtype of the anomaly. Early recognition is very important, especially in young adults.
References
Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 1986 May;111(5):941-63. doi: 10.1016/0002-8703(86)90646-0. PMID: 3518378. https://doi.org/10.1016/0002-8703(86)90646-0
Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology. 1979 Jan;130(1):39-47. doi: 10.1148/130.1.39. PMID: 758666. https://doi.org/10.1148/130.1.39
Desmet W, Vanhaecke J, Vrolix M, Van de Werf F, Piessens J, Willems J, de Geest H. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J. 1992 Dec;13(12):1637-40. doi: 10.1093/oxfordjournals.eurheartj.a060117. PMID: 1289093. https://doi.org/10.1093/oxfordjournals.eurheartj.a060117
Shirani J, Roberts WC. Solitary coronary ostium in the aorta in the absence of other major congenital cardiovascular anomalies. J Am Coll Cardiol. 1993 Jan;21(1):137-43. doi: 10.1016/0735-1097(93)90728-j. PMID: 8417054. https://doi.org/10.1016/0735-1097(93)90728-J
Kervancioglu M, Tokel K, Varan B, Yildirim SV. Frequency, origins and courses of anomalous coronary arteries in 607 Turkish children with tetralogy of Fallot. Cardiol J. 2011;18(5):546-51. doi: 10.5603/cj.2011.0011. PMID: 21947991. https://doi.org/10.5603/CJ.2011.0011
Yuksel S, Meric M, Soylu K, Gulel O, Zengin H, Demircan S, Yilmaz O, Sahin M. The primary anomalies of coronary artery origin and course: A coronary angiographic analysis of 16,573 patients. Exp Clin Cardiol. 2013 Spring;18(2):121-3. PMID: 23940436; PMCID: PMC3718591.
Tuncer C, Batyraliev T, Yilmaz R, Gokce M, Eryonucu B, Koroglu S. Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: multicenter data collection. Catheter Cardiovasc Interv. 2006 Oct;68(4):574-85. doi: 10.1002/ccd.20858. PMID: 16969852. https://doi.org/10.1002/ccd.20858
Turkmen S, Yolcu M, Sertcelik A, Ipek E, Dokumaci B, Batyraliev T. Single coronary artery incidence in 215,140 patients undergoing coronary angiography. Folia Morphol (Warsz). 2014 Nov;73(4):469-74. doi: 10.5603/FM.2014.0070. PMID: 25448905. https://doi.org/10.5603/FM.2014.0070
Elbadawi A, Baig B, Elgendy IY, Alotaki E, Mohamed AH, Barssoum K, Fries D, Khan M, Khouzam RN. Single Coronary Artery Anomaly: A Case Report and Review of Literature. Cardiol Ther. 2018 Jun;7(1):119-123. doi: 10.1007/s40119-018-0103-4. Epub 2018 Feb 6. PMID: 29411245; PMCID: PMC5986668. https://doi.org/10.1007/s40119-018-0103-4
Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990 Sep;21(1):28-40. doi: 10.1002/ccd.1810210110. PMID: 2208265. https://doi.org/10.1002/ccd.1810210110
Braun MU, Stolte D, Rauwolf T, Strasser RH. Single coronary artery with anomalous origin from the right sinus Valsalva. Clin Res Cardiol. 2006 Feb;95(2):119-21. doi: 10.1007/s00392-006-0330-x. Epub 2006 Jan 16. PMID: 16598522. https://doi.org/10.1007/s00392-006-0330-x
Shrivastava S, Mohan JC, Mukhopadhyay S, Rajani M, Tandon R. Coronary artery anomalies in tetralogy of Fallot. Cardiovasc Intervent Radiol. 1987;10(4):215-8. doi: 10.1007/BF02593873. PMID: 3115578. https://doi.org/10.1007/BF02593873
Antonellis J, Rabaouni A, Kostopoulos K, Margaris N, Kranidis A, Salahas A, Ifantis G, Koroxenidis G. Single coronary artery from the right sinus of Valsalva, associated with absence of left anterior descending and an ostium-secundum-type atrial septal defect: a rare combination. A case report. Angiology. 1996 Jun;47(6):621-5. doi: 10.1177/000331979604700612. PMID: 8678338. https://doi.org/10.1177/000331979604700612
Maron BJ. Sudden death in young athletes. N Engl J Med. 2003 Sep 11;349(11):1064-75. doi: 10.1056/NEJMra022783. PMID: 12968091. https://doi.org/10.1056/NEJMra022783
Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000 May;35(6):1493-501. doi: 10.1016/s0735-1097(00)00566-0. PMID: 10807452. https://doi.org/10.1016/S0735-1097(00)00566-0
Virmani R, Burke AP, Farb A. Sudden cardiac death. Cardiovasc Pathol. 2001 Sep-Oct;10(5):211-8. doi: 10.1016/s1054-8807(01)00091-6. PMID: 11673058. https://doi.org/10.1016/S1054-8807(01)00091-6
Sato Y, Inoue F, Kunimasa T, Matsumoto N, Yoda S, Tani S, Takayama T, Uchiyama T, Tanaka H, Furuhashi S, Takahashi M, Koyama Y, Saito S. Diagnosis of anomalous origin of the right coronary artery using multislice computed tomography: evaluation of possible causes of myocardial ischemia. Heart Vessels. 2005 Nov;20(6):298-300. doi: 10.1007/s00380-005-0826-8. PMID: 16314914. https://doi.org/10.1007/s00380-005-0826-8
Kariofillis P, Mastorakou I, Voudris V. Images in intervention. Origin of right and left coronary arteries from the right sinus of Valsalva as a common coronary trunk. JACC Cardiovasc Interv. 2009 Aug;2(8):805-6. doi: 10.1016/j.jcin.2009.05.021. PMID: 19695552. https://doi.org/10.1016/j.jcin.2009.05.021
Taylor AJ, Byers JP, Cheitlin MD, Virmani R. Anomalous right or left coronary artery from the contralateral coronary sinus: "high-risk" abnormalities in the initial coronary artery course and heterogeneous clinical outcomes. Am Heart J. 1997 Apr;133(4):428-35. doi: 10.1016/s0002-8703(97)70184-4. PMID: 9124164. https://doi.org/10.1016/S0002-8703(97)70184-4
Angelini P, Velasco JA, Flamm S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002 May 21;105(20):2449-54. doi: 10.1161/01.cir.0000016175.49835.57. PMID: 12021235. https://doi.org/10.1161/01.CIR.0000016175.49835.57
Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992 Sep;20(3):640-7. doi: 10.1016/0735-1097(92)90019-j. PMID: 1512344. https://doi.org/10.1016/0735-1097(92)90019-J
Yurtdaş M, Gülen O. Anomalous origin of the right coronary artery from the left anterior descending artery: review of the literature. Cardiol J. 2012;19(2):122-9. PMID: 22461044. https://doi.org/10.5603/CJ.2012.0023
Echavarría-Pinto M, Rodríguez-Rodríguez E, Macías E, Kimura-Hayama E. Extremely rare single right coronary artery: multidetector computed tomography findings. Arch Cardiol Mex. 2012 Apr-Jun;82(2):195-6. PMID: 22735660.
Datta J, White CS, Gilkeson RC, Meyer CA, Kansal S, Jani ML, Arildsen RC, Read K. Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography. Radiology. 2005 Jun;235(3):812-8. doi: 10.1148/radiol.2353040314. Epub 2005 Apr 15. PMID: 15833984. https://doi.org/10.1148/radiol.2353040314
Yoda S, Sato Y, Matsumoto N, Tani S, Takayama T, Nishina H, Uchiyama T, Saito S. Incremental value of regional wall motion analysis immediately after exercise for the detection of single-vessel coronary artery disease: study by separate acquisition, dual-isotope ECG-gated single-photon emission computed tomography. Circ J. 2005 Mar;69(3):301-5. doi: 10.1253/circj.69.301. PMID: 15731535. https://doi.org/10.1253/circj.69.301
Zhang LJ, Yang GF, Huang W, Zhou CS, Chen P, Lu GM. Incidence of anomalous origin of coronary artery in 1879 Chinese adults on dual-source CT angiography. Neth Heart J. 2010 Oct;18(10):466-70. doi: 10.1007/BF03091817. PMID: 20978590; PMCID: PMC2954298. https://doi.org/10.1007/BF03091817
Rudan D, Todorovic N, Starcevic B, Raguz M, Bergovec M. Percutaneous coronary intervention of an anomalous right coronary artery originating from the left coronary artery. Wien Klin Wochenschr. 2010 Aug;122(15-16):508-10. doi: 10.1007/s00508-010-1420-3. Epub 2010 Aug 2. PMID: 20676783. https://doi.org/10.1007/s00508-010-1420-3
Calişkan M, Ciftçi O, Güllü H, Alpaslan M. Anomalous right coronary artery from the left sinus of Valsalva presenting a challenge for percutaneous coronary intervention. Turk Kardiyol Dern Ars. 2009 Jan;37(1):44-7. PMID: 19225253.
Kafkas N, Triantafyllou K, Babalis D. An isolated single L-I type coronary artery with severe LAD lesions treated by transradial PCI. J Invasive Cardiol. 2011 Sep;23(9):E216-8. PMID: 21891816.
Iio K, Nandate H, Nakamura T, Nakashima Y, Kuroiwa A. The study of a case of single coronary artery using stress 201thalium single photon emission computed tomogram. J UOEH. 1989 Mar 1;11(1):55-62. doi: 10.7888/juoeh.11.55. PMID: 2497506. https://doi.org/10.7888/juoeh.11.55
Said SA, de Voogt WG, Bulut S, Han J, Polak P, Nijhuis RL, Op den Akker JW, Slootweg A. Coronary artery disease in congenital single coronary artery in adults: A Dutch case series. World J Cardiol. 2014 Apr 26;6(4):196-204. doi: 10.4330/wjc.v6.i4.196. PMID: 24772259; PMCID: PMC3999339. https://doi.org/10.4330/wjc.v6.i4.196
Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, Daliento L. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol. 1998 Jul;29(7):689-95. doi: 10.1016/s0046-8177(98)90277-5. PMID: 9670825. https://doi.org/10.1016/S0046-8177(98)90277-5
Rinaldi RG, Carballido J, Giles R, Del Toro E, Porro R. Right coronary artery with anomalous origin and slit ostium. Ann Thorac Surg. 1994 Sep;58(3):829-32. doi: 10.1016/0003-4975(94)90760-9. PMID: 7944711. https://doi.org/10.1016/0003-4975(94)90760-9
Izumiyama O, Yamashita A, Sugimoto S, Baba M, Hasegawa T. [Coronary artery bypass grafting in two patients with single coronary artery]. Kyobu Geka. 1999 Feb;52(2):143-7. Japanese. PMID: 10036876.
Neiva J, Passos Silva M, Pires-Morais G, Dias A, Ponte M, Caeiro D, Braga JP, Ferreira N, Ribeiro V. Right single coronary artery as an incidental finding in Takotsubo syndrome and acute heart failure: Case report and review of the literature. Rev Port Cardiol. 2019 Mar;38(3):215-223. English, Portuguese. doi: 10.1016/j.repc.2018.06.013. Epub 2019 Apr 20. PMID: 31014998. https://doi.org/10.1016/j.repc.2018.06.013
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