A rare coronary anomaly consisting of a single right coronary ostium in an adult undergoing surgical coronary revascularization: a case report and review of the literature

Abstract

BackgroundCoronary arteries originating from the right coronary ostium in the ascending aorta represent a very rare anatomic presentation. Also, the presence of a single coronary ostium is an extremely rare finding.Case presentationWe present the case of a 74-year-old Albanian man from Kosovo. He had unstable angina due to critical triple vessel disease and a single coronary artery originating from a single ostium in the right sinus of Valsalva with an anomalous course of his left anterior descending artery anteriorly to the right ventricular outflow tract as a “T-vessel” from which originated the proximal and distal left anterior descending artery, the circumflex artery originating from the mid portion of the right coronary artery which had a normal course. He underwent successful coronary revascularization consisting of three vein grafts to the right coronary artery, first diagonal and obtuse marginal artery, and left internal mammary artery anastomosed to left anterior descending artery.ConclusionsWe describe a proposed IID1 pattern. After a careful revision of the literature, only six cases have been reported with a similar anomalous coronary origin. Only two out of six patients underwent surgical coronary revascularization. In our case the aberrant vessel arising from his right coronary artery coursed anteriorly to the right ventricle and continued as a left anterior descending artery at its mid portion which then continued distally as the distal left anterior descending artery and proximally as a proximal left anterior descending artery, having the shape of a “T vessel”. The “T-vessel” configuration has never been reported in the literature.The reported case with its specific presentation adds further information on this rare form of anomalous origin of the coronary arteries, representing a first report of a configuration that we name the “T-vessel” of the left anterior descending artery. Diagnosis of the coronary anatomy is very important for the invasive cardiologist and cardiac surgeon in cases with a single coronary ostium, such as our case, so that they can proceed with the invasive or surgical treatment when critical coronary artery disease is present.

Single coronary artery originating from right sinus. Role of MDCT and a review of literature

“…The pathogenic mechanism at the basis of ischemic cardiopathy in patients with this rarer type of SCA is more complex and not well determined. It could be functional, when the single coronary artery becomes insufficient to support myocardial oxygen consumption during exercise, or it could be caused by coronary atherosclerosis [8]. The patients described above had multiple cardiovascular risk factors which justify the finding of diffuse calcific plaques by MDCT.…”

“…These two patients, whose SCA originates from the right sinuses, have the rarest coronary anomaly, with a prevalence around 0.02-0.05% in general population [1]. Moreover, the configuration of coronary anatomy of patient 2, with an anomalous course of LAD anterior to the right ventricular outflow tract trunk as a "T vessel", was described only in one case by Prifti et al [8]. Although SCA detection is often an incidental finding, diagnosis is important, and its recognition is more common today because of increasing use of MDCT [1].…”

“…The most frequent complications occurring in patients with SCA are sudden cardiac death (SCD) and cardiac ischemia [1,7]. SCD is significantly higher in patients with inter-arterial course of SCA (between aorta and pulmonary trunk), where the "kinking" of the coronary at its origin caused by the distention of the aorta during exercise has been advocated as the principal pathogenic mechanism [8,9]. Anyway, in our two cases inter-arterial course of SCA was carefully ruled out by MDCT.…”

An Extremely Rare Case of Anomalous Left Main Coronary Artery Originating From Single Right Coronary Ostium Managed Using Heart Team Approach

“…A variety of coronary artery anomalies of varying clinical significance have been reported in contemporary literature [1,2,5,6]. And some of these anomalies can result in serious clinical outcomes including but not limited to sudden cardiac death, chest pain and arrhythmias.…”

“…Diagnosing patients early on may be difficult because children and adolescents are often asymptomatic and first presentation may be sudden death or sudden cardiac arrest. Such anomalous origin arteries can also develop atherosclerotic lesions later on in life with patients having atherosclerotic cardiovascular disease (ASCVD) risk factors [1][2][3]. Open Access Case Report DOI: 10.7759/cureus.8879…”