Single coronary artery from the right coronary sinus with proximal origin of the left anterior descending coronary artery and left circumflex as distal continuation of the right coronary artery : a rare variant : case report - online article

Abstract

A single coronary artery is a rare coronary anomaly. A 68-year-old male underwent coronary angiography for recent inferior wall myocardial infarction. It revealed a common coronary trunk arising from the right sinus of Valsalva and bifurcated into the right coronary artery (RCA) and anterior descending coronary arteries. The RCA, after its usual distribution in the right atrioventricular groove, continued as the left circumflex artery in the left atrioventricular groove. There were significant stenoses in the mid and distal RCA, which were treated percutaneously.

Single Coronary Artery from Right Sinus of Valsalva: A Single Center Experience of Seven Cases

“…Even in the literature, it is unclear whether such cases should be classified as single coronary systems or not. A similar type of case was reported by Subban et al [ 7 ] where the RCA and LAD arose from the right sinus and the RCA continued as the LCX distally, along with a small diminutive diagonal branch from the left sinus. They had described such a case as a single coronary system as the majority of the heart was supplied by the right coronary system [ 7 ].…”

“…A similar type of case was reported by Subban et al [ 7 ] where the RCA and LAD arose from the right sinus and the RCA continued as the LCX distally, along with a small diminutive diagonal branch from the left sinus. They had described such a case as a single coronary system as the majority of the heart was supplied by the right coronary system [ 7 ]. We need further data to update these classification systems to include such cases.…”

Clinical Implications of Congenital Absence of Circumflex Coronary Artery

“…In the majority of reported cases, the RCA originated from the distal CX, 4,5 whereas CX originating from the distal RCA has been reported in only a few cases associated with a single coronary anomaly. 2,3 The congenital absence of the left CX is also rarely reported. In such cases, the posterolateral branch of the RCA is usually well-developed, and it courses to the circumflex territory.…”

“…The CX usually arises from the distal RCA. 2,3 Based on the size of the CX and perfusion of the circumflex territory, clinical symptoms may vary from an asymptomatic condition to an acute coronary syndrome. Herein, a case in which CX originated as a continuation of the posterolateral branch of the RCA with a separate left anterior descending (LAD) artery origination from the left sinus of Valsalva.…”

Single coronary artery from right coronary sinus presenting with acute coronary syndrome

“…when the anomalous coronary artery runs between the aorta and main pulmonary artery or/and patients with atherosclerosis may benefit from revascularisation strategies. Successful percutaneous coronary intervention has also been reported in some cases depending upon the presentation and site of the lesion [3]. Until the advent of more sophisticated imaging modalities such as MDCT and MRI, the delineation of the anatomical course relied solely on the 'dot and eye' method and/or pulmonary artery catheter placement.…”