Percutaneous coronary intervention in a patient with a single right coronary artery: A case report and review of the literature

Abstract

The present report discusses a case of successful percutaneous coronary intervention to abnormally originating circumflex and diagonal arteries arising from the right sinus of Valsalva in a patient with a single right coronary artery. The incidence of this rare abnormality, frequency of atherosclerosis and interventional procedures in this group of patients are discussed, and a review the literature is presented. Key Words: Coronary abnormalities; Percutaneous coronary intervention; Single right coronary arteryI solated single coronary arteries are rare congenital malformations. In this abnormality, a single coronary artery originates from the aortic trunk by a single ostium and supplies the entire myocardium regardless of its distribution (1). These arteries are just as prone to atherosclerosis as normally arising coronary arteries. Although stenoses of anomalous arteries have been previously described, percutaneous coronary interventions (PCI) on such anomalies are rarely reported. Some technical difficulties regarding PCI for a single coronary artery may occur because of the unusual course and tortuous angle of the coronary artery branch to be dilated. Good coaxial guide support is necessary during the procedure. We present a case with an R-IIIC-type single right coronary artery that had critical stenoses at the diagonal and (LCx) branches. Successful PCI was performed on both branches arising separately from a single right coronary artery. CASE PRESENTATIONA 55-year-old woman with hypertension was admitted to the coronary care unit in the Dokuz Eylul University School of Medicine, Izmir, Turkey, with a diagnosis of non-Q wave myocardial infarction. Medical history revealed typical exertional chest pain over the previous six months. Her physical examination was unremarkable. An electrocardiogram showed lateral T-wave inversion. All cardiac enzymes were slightly elevated. The left coronary artery was not visible on angiography, which was performed two days after admission. Selective right coronary arteriography revealed a single ostium in the right sinus of Valsalva (RSV) giving rise to the right coronary artery, whereas the left anterior descending (LAD) and LCx arteries originated as a separate branch from this vessel after a very short common trunk. The LCx artery ran behind the aorta, whereas the LAD artery crossed the base of the heart anterior to the major great vessels, then descended along the anterior interventricular groove and coursed along with the diagonal artery in the normal position (Figure 1). The aortography confirmed the absence of the coronary artery arising from the left coronary sinus of Valsalva. There was a 95% focal, eccentric stenosis in the distal portion of the diagonal artery and a 70% stenosis in the proximal portion of the anomalous LCx. No other associated congenital cardiac abnormality was detected by echocardiography. The patient was readmitted to the catheterization laboratory for elective PCI on the diagonal and LCx arteries. The single right coronary ostium was selectively ...

High-risk percutaneous coronary intervention in a patient with a single coronary artery presenting as STEMI and cardiogenic shock

“…Coronary interventions in patients with anomalous vessels have rarely been reported 8. These interventions carry a high procedural risk because any complication in a sole arterial supply to the myocardium, like dissection or slow flow, may lead to a life-threatening eventuality.…”

Advances in revascularization of the left coronary artery

“…Rarely, patients can also present with a single right coronary artery that comes from a circumflex and diagonal arteries that arise from the right sinus of Valsalva. Anomalies like these increase the risk of atherosclerosis and lead to further complications [52,53].…”

“…documented a patient with an R-IIIC-type single right coronary artery with critical stenosis at the diagonal and left circumflex branches. Additionally, a literature review of PCI performed in R-III-type single right coronary artery anomalies concluded that the most appropriate intervention of choice was PCI despite the risks associated with it [53].…”

Totally occluded left main coronary artery originating from right coronary artery in a patient presenting with STEMI and cardiogenic shock

“…But rarely these cases may present as acute myocardial infarction in older ages. Coronary interventions in patients with anomalous vessels have rarely been reported [7]. These interventions are challenging and carry high procedural risks; hence proper techniques of intervention and selection of guiding catheters are important.…”