Coronary artery disease in congenital single coronary artery in adults: A Dutch case series

Abstract

SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis. The availability and sophistication of MSCT facilitates the delineation of the course of a SCA. We present a Dutch case series and review of the literature.

Complex single ostium coronary artery from the right coronary sinus with unique course of anomalous left circumflex coronary artery

“…However, we consider additional diagnostic stress imaging to evaluate it if angina recurs during the outpatient follow up in this patient. Similarly to the previous cases [3][4][5], CCTA played a pivotal role to delineate the complex coronary anatomy of this case and our experience further supports utilization of CCTA as a part of full evaluation of SOCAs [3][4][5]. The long-term clinical significance of this coronary anatomy is uncertain at this point due to a rare incidence of this coronary anatomy.…”

“…In group III, LCX and RCA arise from a common trunk separately [2]. In the III class to which our case is classified, LCX and LAD have been reported to cross either behind aorta (retroaortic), interarterial, anterior to the pulmonary artery, or course intramyocardially in the previous literature [1][2][3][4][5]. Yamanaka et al have reported that the incidence of SOCA with Lipton R-III classification is 0.004% [1].…”

“…However, their case did not show a portion of intramuscular course of the anomalous LCX and it did show a portion of the anomalous LCX coursed in the arterioventricular groove, which findings were different from those of our case. The interarterial course of anomalous coronary artery has been known for a risk of cardiac sudden death associated with SOCAs in the literature [1,3]. We favored medical management of this case because of the lack of this high-risk anomalous coronary course and probable troponin elevation due to a combination of small area ischemia of the first diagonal branch territory with uncontrolled hypertension.…”

“…The incidence of single ostium coronary artery (SOCA) is reported to be 0.0448% in patients who underwent invasive coronary angiography [1] and it may be a culprit for angina, arrhythmias, and possibly sudden death [1][2][3]. Coronary computed tomography angiography (CCTA) is advocated to characterize these anomalies in conjunction with invasive coronary angiography [3][4][5].…”

“…The incidence of single ostium coronary artery (SOCA) is reported to be 0.0448% in patients who underwent invasive coronary angiography [1] and it may be a culprit for angina, arrhythmias, and possibly sudden death [1][2][3]. Coronary computed tomography angiography (CCTA) is advocated to characterize these anomalies in conjunction with invasive coronary angiography [3][4][5]. Among SOCAs, a pattern of R-III Lipton classification in which left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) occur separately from single coronary artery arising from the right coronary sinus is considered to be very rare with known incidence of 0.004% among patients having invasive coronary angiography.…”