Review of Single Coronary Artery with Report of 2 Cases

Abstract

The paper includes a discussion of all published cases of single coronary artery and a consideration of the embryologic development and physiologic significance of this anomaly. The incidence and types of associated cardiac diseases are reviewed. Two additional case reports of this anomaly are included.T HE OCCURRENCE of a single coronary artery is such a rare cardiac anomaly that presentation of 2 additional cases is of interest. The first case is unique in that the patient was the oldest in whom such an anomaly has been reported. In addition, pertinent data on 43 previously reported cases are presented.CASE REPORTS Case 1.-The patient was a white woman, 80 years of age, who entered University Hospitals of Cleveland with complaints of constipation and severe nausea for the past twenty-four hours and sharp attacks of pain over the lower abdomen of twelve hours' duration. She had never experienced chest pain, shortness of breath or edema of the ankles. Physical examination revealed a firm mass in the rectum and a sigmoid colostomy was performed on the day of hospital admission. On the thirteenth hospital day an abdominoperineal resection was performed and examination of the specimen disclosed a partially differentiated adenocarcinoma of the rectum. Metastases were not found. Edema of the legs and ankles developed on the fourth hospital day. The patient became comatose and died on the eleventh hospital day. Autopsy and both branches extended obliquely over the anterior surface of the left ventricle, the larger continuing to the apex where it could be followed over the posterior surface of the left ventricle for 2 cm.Cross sections of the first portion of the larger anterior descending branch revealed yellowish gray intimal plaques that nearly occluded the lumen. The circumflex branch of the left coronary artery extended around the posterior surface of the left ventricle along the atrioventricular groove to the acute margin of the heart and continued to the anterior surface of the right ventricle to the base of the right auricular appendage. The course of this vessel measured 25 cm. from aortic orifice to the base of the right auricular appendage ( fig. 1). Cross sections revealed a patent lumen throughout with slight focal thickening of the intima by yellowish gray plaques. Small branches extended over the posterior surface of both ventricles and over the anterior surface of the right ventricle.Histologic examination of the myocardium revealed moderately large muscle fibers with nuclei that were slightly enlarged and occasionally rectangular. The myocardium was not otherwise remarkable. Histologic sections of the first portion of the larger branch of the left anterior descending coronary artery revealed marked thickening of the intima and subintimal deposition of a large amount of eosinophilic material containing acicular spaces. The lumen was reduced to a slit.The pathologic diagnoses included recent abdominoperineal resection for partially differentiated adenocarcinoma of the rectum, acute fibrino-purulent per...

Unique Single Coronary Artery with Acute Myocardial Infarction. Observation of the Culprit Lesion by Intravascular Ultrasound and Coronary Angioscopy.

“…Several mechanisms of myocardial ischemia in single coronary artery, such as entrapment of an anatomically ectopic artery between the aorta and the pulmonary trunk, 2) flap-like ostium closure, 3) coronary vasospasm, 4) slow controlled ischemia, 5) and atherosclerotic change in the coronary artery 6) have been proposed. In this case, acute myocardial infarction was attributed to a significant stenosis at the middle portion in the left anterior descending artery, which was subsequently dilated by a coronary stent.…”

“…1) A single coronary artery is often associated with myocardial ischemia and additional cardiac congenital anomalies. [2][3][4][5][6] We report a patient with an isolated single coronary artery and an acute myocardial infarction. This case deals with a very unusual type of single coronary artery in which the right coronary artery originated from the middle portion in the left anterior descending artery through the transverse branch.…”

Coronary artery conundrum: A single coronary artery with origin of the right coronary artery from the distal left circumflex artery

“…The first classification system for single coronary artery was proposed by Smith [5] in 1950 [6]. He put forth the idea of three categories according to the distribution of the single coronary artery.…”

Coronary arterial spasm in single right coronary artery

“…The entire myocardium of the heart with a single-coronary artery is nourished by an artery, regardless of distribution, that arises by one ostium from an arterial trunk (Smith, 1950). The diagnosis of the coronary artery anomalies had depended on the coronary angiography for several decades.…”

“…The current classification system of solitary coronary artery was proposed by Lipton et al(1979), who incorporated two previous systems defined by Smith (1950) and Ogden and Goodyear (1970), respectively, into one final system. Based on those classifications, the first division was made between the 'R' right-type and 'L' left-type according to the site of origin of the single-coronary artery (i.e., in the right or left Valsalva's sinus).…”