A Single Coronary Artery Anomaly: Right Coronary Artery as a Branch From the Left Anterior Descending Artery

Abstract

An anomalous origin of the right coronary artery (RCA) from the left anterior descending artery (LAD), also known as a single coronary artery, is an extremely rare finding in clinical practice. It is usually a benign anomaly; however, symptoms are highly dependent on the course that the anomalous RCA takes after branching off of the LAD. We present a case of a patient who had decompensated heart failure and was detected to have a single coronary artery. The patient was treated with guideline-directed medical therapy with notable improvement in clinical status in the following days. Enhanced awareness of congenital cardiac anomalies may help guide management.

Anomalous Origin of the Right Coronary Artery From the First Septal Perforator

“…Patients with coronary artery anomalies can be asymptomatic or experience angina, syncope, or even sudden cardiac death [6]. Some of the proposed mechanisms by which these symptoms occur include spasm of the anomalous artery, the acute angle of takeoff of the anomalous artery, the shape of the orifice from which the anomalous artery originates, and an intramural course of the anomalous artery [3].…”

“…Usually, it originates from the proximal or mid-portion of the left anterior descending artery; it also frequently originates distal to the first septal perforator and sometimes distal to the second septal perforator [4]. Less than 50 cases have been reported of the right coronary artery stemming from the left anterior descending artery [1][2][3][4][5][6][7]. In this report, we present an exceptionally rare case of an anomalous right coronary artery originating from the first septal perforator.…”