A 58-year-old male patient was admitted for coronary angiography two months after he suffered non-ST elevation myocardial infarction (NSTEMI) of the lateral wall. A coronary angiography (Fig. 1A) showed presence of a single coronary artery arising from the right sinus of Valsalva, comprising three clustered, separated coronary artery ostia (“triple-barrel”), and absence of significant stenosis. A 64-slice multidetector cardiac computer tomography confirmed this rare variant of the single coronary artery (Fig. 1B–C), as well as the benign anterior course of aberrant LAD to the pulmonary artery (Fig. 1D). Echocardiography demonstrated absence of other cardiac abnormalities. The patient was discharged with optimal medical therapy.
Figure 1.
Single coronary artery arising from the right sinus of Valsalva, demonstrated by coronary angiography (A) and confirmed by multidetector cardiac computer tomography (B). “Tripple-barrel” pattern of ostium of the single coronary artery presented with a magnified view (C), as well as the benign anterior course of LAD (D).
Single coronary artery (SCA) is a very rare congenital coronary artery anomaly with the estimated incidence of 0.02% in adult patients, usually associated with other cardiac anomalies such as Fallot tetralogy, transposition of great arteries, persistent truncus arteriosus and pulmonary atresia [1]. The current classification system of SCA was proposed by Lipton et al. [2] and the variant of SCA found in our patient is the rarest. Isolated single coronary artery is usually asymptomatic and the prevailing opinion is that it is not prone to the development of atherosclerosis [3]. Possible myocardial ischemia and sudden cardiac death are thought to be associated with interarterial course of aberrant LAD between aorta and the pulmonary artery with subsequent compression [4]. In our patient, isolated SCA was associated with anterior course of LAD and absence of significant atherosclerotic plaques, although the patient had previously suffered NSTEMI.
Footnotes
Peer review under responsibility of King Saud University.
References
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