Single coronary artery incidence in 215,140 patients undergoing coronary angiography

A Patient With Single Coronary Artery and Pectus Excavatum Presenting With Non-ST Elevation Myocardial Infarction

We report the case of a 51-year-old male with pectus excavatum (PEX) who presented with stress-related chest pain as a symptom of acute non-ST elevation myocardial infarction. Coronary angiography (CAG) revealed a suspected single coronary artery (SCA) anatomy with diffuse atherosclerotic narrowing, without evidence of other coronary ostia in the aortic root. The diagnosis was confirmed on cardiac computed tomography (CCTA) as the SCA of the R-I type by Lipton classification. The percutaneous coronary intervention was performed with good angiographic results and resolution of symptoms.

Single coronary artery presenting dilated cardiomyopathy and hyperlipidemia with the SCN5A and APOA5 gene mutation: A case report and review of the literature

We present a 55-year-old man with chest tightness and dyspnoea after activity lasting for 2 months who was diagnosed with single coronary artery (SCA) and presented with dilated cardiomyopathy (DCM) with the c.1858C > T mutation in the SCN5A gene. The computed tomography coronary angiogram (CTCA) showed congenital absence of the right coronary artery (RCA), and the right heart was nourished by the left coronary artery branch with no apparent stenosis. Transthoracic echocardiography (TTE) revealed enlargement of the left heart and cardiomyopathy. Cardiac magnetic resonance imaging (CMR) revealed DCM. Genetic testing showed that the c.1858C > T variant of the SCN5A gene could lead to Brugada syndrome and DCM. SCA is a rare congenital anomaly of the coronary anatomy, and this case reported as SCA accompanied by DCM is even rarer. We present a rare case of a 55-year-old man with DCM with the c.1858C > T (p. Arg620Cys)/c.1008G > A (p.(Pro336=) variant of the SCN5A gene, congenital absence of RCA, and c.990_993delAACA (p. Asp332Valfs*5) variant of the APOA5 gene. To our knowledge, this is the first report of DCM combined with the SCN5A gene mutation in SCA after searching the PubMed, CNKI and Wanfang databases.

Single coronary ostium with obstructive hypertrophic cardiomyopathy treated using the Morrow procedure: a case report

BACKGROUND

Hypertrophic cardiomyopathy is a commonly inherited heart disease. In addition, single coronary artery (SCA) is a rare congenital anomaly of the coronary arteries. And SCA concomitant with severe hypertrophic obstructive cardiomyopathy (HOCM) has seldom been reported in the literature. However, such cases have not been reported to be treated with the Morrow procedure.

CASE PRESENTATION

Herein, we presented a case of a 64-year-old female diagnosed with a single left coronary artery with severe HOCM. The HOCM was treated with the Morrow procedure. The patient was discharged on the seventh postoperative day and was asymptomatic during the follow-up.

CONCLUSION

To our knowledge, this is the first study reporting a single left coronary artery with severe HOCM treated with the Morrow procedure. In addition, myocardial protection by cardioplegia antegrade perfusion was safe for the patient with SCA and HOCM.

Coronary Artery Anomaly, What Radiologist Should Know?

심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.

A Rare Anatomical Variant: Congenital Absence of the Right Coronary Artery with Left Circumflex Artery Supplying the Right Coronary Artery (RCA) Territory

Patient: Female, 66-year-old

Final Diagnosis: Coronary artery anomalies

Symptoms: Chest discomfort • shortness of breath

Medication: —

Clinical Procedure: Coronary angiography

Specialty: Cardiology

Case report: echocardiographic detection of rare single coronary artery anomaly in a child with an atrial septal defect

Background

A single right coronary artery (RCA) with the left anterior descending (LAD) and circumflex coronary arteries located in the usual anatomic position and supplied by collaterals is the rarest variant of single RCA.

Case summary

We report a paediatric patient with an incidental finding of single RCA Lipton type RI pattern during assessment for transcatheter device closure of an ostium secundum atrial septal defect (secASD). Transthoracic echocardiography (TTE) revealed a dilated RCA, abnormal flow in the LAD, and no identifiable left main coronary artery. Diagnosis of a single RCA was confirmed with angiography. Dobutamine stress echocardiography revealed no inducible ischaemia. Transcatheter device closure of the secASD was subsequently successfully performed.

Discussion

TTE in paediatric patients can raise suspicion of coronary artery origin anomalies. Additional modalities, such as computed tomography and angiography, are required to comprehensively determine coronary artery anatomy. Functional assessment of ventricular function is also indicated. Coronary artery anatomy is important to delineate prior to transcatheter device closure of a secASD and should be part of the pre-procedure assessment.

Widowmaker Right Coronary Artery Treated With Drug-Eluting Stent Implantation

We present a case of a single coronary artery system arising from the right sinus of Valsalva found to have an obstructive mid-vessel lesion with functional evidence of ischemia on stress testing. She was treated with a first-generation Cypher (Cordis, Johnson & Johnson, Hialeah, Florida) drug-eluting stent and remains asymptomatic at 14-year follow-up. (Level of Difficulty: Intermediate.)

Prevalence and Anatomic Characteristics of Single Coronary Artery Diagnosed by Computed Tomography Angiography

Single coronary artery (SCA) is a rare congenital anomaly. We assessed the prevalence and anatomic characteristics of SCA diagnosed with coronary computed tomography angiography and compared the dimensions of the proximal SCA trunk with a reference group of 199 subjects with normal coronary arteries. We screened 30,230 patients who underwent coronary computed tomography angiography from 2008 to 2018 to identify 17 with SCA (age 55 ± 19.0 years, 8 men [47%]). The prevalence of SCA was 0.056%. SCA originated from the right sinus of Valsalva in 11 patients (65%) and from the left sinus of Valsalva in 6 subjects. According to Lipton's classification, the 17 SCAs were L1 (n = 5, 29%), L2-A (n = 1, 6%), R2-A (n = 2, 12%), R2-B (n = 6, 35%), R2-P (n = 2, 12%), and R3 (n = 1, 6%). (Lipton's classification consists of 3 groups and the division is based on the site of origin of SCA ["R" - right, "L" - left sinus of Valsalva] and its anatomical course relating to the ascending aorta and pulmonary trunk ["A" - anterior to the pulmonary trunk, "B" - between the aorta and pulmonary trunk, "P" - posterior to the aorta].) As compared with the reference group, SCA patients had shorter proximal trunks (5.0 ± 3.6 mm vs 8.6 ± 4.8 mm, p = 0.0012). The lumen area (LA) and lumen diameter of the proximal trunk in patients with SCA were larger than the LA and lumen diameter of the left main coronary artery from the reference group (49.5 ± 18.0 mm2 vs 21.3 ± 6.5 mm2, p <0.0001, and 7.8 ± 1.6 mm vs 5.1 ± 0.75 mm, p <0.0001, respectively). Moreover, the LA of the proximal SCA trunk was larger than the sum of respective measurement performed in left main coronary artery and proximal right coronary artery segments in the control group (49.5 ± 18.0 mm2 vs 34.0 ± 7.9mm2, p = 0.0001). In conclusion, the incidence of SCA is very low; but this condition is associated with significant enlargement of the proximal vessel segment.

Hypoplastic left anterior descending artery associated with a single coronary artery

Coronary artery anomalies are rarely seen in patients undergoing coronary arteriography. Single coronary artery anomaly is a rare subgroup. Hypoplastic coronary artery is a rare entity which refers to congenital underdevelopment of one or more main branches of the coronary arteries. The combination of these is extremely rare. Herein, we present a 64-year-old female case with a single coronary artery classified as type R-III with hypoplastic left anterior descending artery.

Congenital absence of the right coronary artery: A case report and literature review

RATIONALE

Congenital absence of the right coronary artery (RCA) is a rare congenital malformation of the cardiovascular system which may have fatal consequences.

PATIENT CONCERNS

A 63-year-old man with a 5-year history of chest pain after exertion which had aggravated for >1 month was advised for admission and computed tomography angiography (CTA) examination of the coronary artery to screen for coronary artery disease (CAD).

DIAGNOSES

The coronary artery CTA showed absence of RCA arising form the aortic root after which a selective coronary angiography (SCA) examination was done that confirmed the diagnosis of congenital absence of RCA.

INTERVENTIONS

As the patient refused to receive a coronary artery stent implantation citing his financial condition, only symptomatic treatment was given.

OUTCOMES

The patient requested to be discharged from the hospital against the advice of his doctors 1 week later. A query made by the telephone suggested that the patient's symptoms were under control by use of prescribed medications only.

LESSONS

Although being a rare condition, a coronary artery CTA examination can be utilized to screen for congenital absence of RCA and other varieties of cardiovascular malformation whereas SCA can be performed to confirm the diagnosis.

Report on a rare single coronary artery anomaly: Need for comprehensive investigations

Single coronary artery anomaly (SCAA) is a very rare disorder with an incidence of about 0.024%–0.066% which presents with the diverse feature but is mostly asymptomatic. It has found to be one of the pathological states to cause sudden death. We report a case of R-III type of SCAA as classified by Lipton et al. which is only about 15% of all the cases of SCAA which makes it even rarer. Hypoxic environment is thought to be an important cause for the development of such anomalies which gives us clues to determine the predisposing factors to be ruled out in patient's history. Coronary angiography is the key toward definitive diagnosis which can be later supported by computed tomography scan and determination of its subtypes. Depending on the findings and physical state of the patient, medical or surgical treatment can be defined but only after correct diagnosis by comprehensive investigations.

Single coronary artery from right aortic sinus in a very elderly patient

In the absence of other associated cardiac anomalies, single coronary artery (SCA) per se is a rare anomaly detected during coronary angiography or autopsy. Various types of SCA detected during coronary angiography have already been described. We herein report a type of SCA originating from the right sinus of Valsalva, with the right circumflex, left circumflex, and left anterior descending coronary arteries arising from the proximal part of the SCA in a 76-year-old female patient. She developed ventricular fibrillation during coronary angiography, which calls for caution while performing a coronary angiogram in such patients.

Coronary arteries of the European bison (Bison bonasus)

Background

The European bison (Bison bonasus) is an endangered species. More information on its anatomy is needed as only few studies have been published. This study is the first report on the morphology of the coronary vessels. Given the anatomical similarity between the European bison and other ruminants, the results of this study can be applied to other species, including endangered ones.

Results

The study was conducted on 70 hearts of European bisons of both sexes, aged 5–20 years, with an average body weight of 449 kg. A distinct view of subepicardial arterial vessels was obtained by filling them with dyed synthetic latex (LBS 3060) and Plastogen G. There was a division of the common trunk of the left coronary artery into the interventricular paraconal branch and the left circumflex branch in 63 individuals (90 %). In five individuals (7.1 %), the presence of a third vessel, which was a branch of the interventricular septum, was observed. There was a lack of a common trunk in two individuals (2.9 %). Ramifications of the interventricular paraconal branch to the wall of the left ventricle were significantly larger than those to the wall of the right ventricle. In 17 individuals (24.3 %), the right coronary artery extended into the subsinuosal interventricular branch.

Conclusion

The blood supply to the heart in bisons is provided by the left and right coronary arteries. In all the studied specimens, the left coronary artery was better developed than the right coronary artery.