Right coronary artery originating from distal left circumflex: an extremely rare variety of single coronary artery

Single coronary artery is a rare congenital anomaly of the coronary circulation which is often associated with other congenital cardiac malformations. Right coronary artery arising from the distal left circumflex artery is an extremely rare variety of single coronary artery. We report a patient with a single coronary artery system, in whom the right coronary artery originated from the distal left circumflex. No other associated cardiac anomaly was detected.     

Right coronary artery originating from distal left circumflex artery in a patient with an unusual type of isolated single coronary artery

Single coronary artery is a rare congenital anomaly and is commonly associated with other congenital cardiac malformations. This report describes a 42-year-old man with an isolated single coronary artery, in whom the right coronary artery did not originate from the aorta but rather from the distal left circumflex artery. This patient did not have any other cardiovascular anomaly. However, he experienced angina pectoris and evidence of myocardial ischemia. Coronary angiography revealed insignificant coronary artery stenosis. He received medical treatment and responded well. An isolated single coronary artery is extremely rare, and this case may be only the 12th case reported in the literature.     

Single left coronary artery and coronary sinus opening anomaly in a patient presenting with cardiac symptoms

A single left coronary artery is an extremely rare congenital anomaly that is commonly associated with other congenital cardiac malformations. We present a case involving a single left coronary artery and coronary sinus anomaly demonstrated on coronary angiography and multidetector computed-tomography angiography. To the best of our knowledge, this rare combination has not been reported previously.     

Anomalous left coronary artery arising from right sinus of valsalva could be a minor congenital anomaly--a case report and review of the literature

Left coronary artery arising from the right sinus of Valsalva is a rare congenital coronary anomaly. This anomaly is either benign or serious, depending on the relation of the anomalous left coronary artery to the aorta and pulmonary artery. Potentially serious anomaly is associated with sudden cardiac death and warrants prophylactic coronary bypass surgery. A rare case of anomalous left coronary artery arising from the right sinus of Valsalva is reported, documented by coronary angiography; however, it took a safer course between the aorta and pulmonary artery. Prophylactic surgery was not performed, for this benign anomaly may not carry the same risk of sudden cardiac death.     

Right coronary artery originating from distal left circumflex: an unusual feature of single coronary artery

This report describes a patient with a single coronary artery system, in whom the right coronary artery originated from the distal left circumflex. A significant stenosis was present just at the take-off of the aberrant right coronary artery. No other associated cardiac anomaly could be demonstrated; the patient was referred for elective bypass surgery.     

Single coronary ostium - a right coronary artery arising from the left main coronary artery

Single coronary ostium is a very rare congenital anomaly with an incidence of 0.024% in angiographic series. This is the third case of Shirani-Roberts subtype IB4: solitary ostium in the left coronary sinus associated with a retroaortic-coursing right coronary artery that arises from the left main coronary artery. The patient is a 45-year-old male with no past medical history, and who was seen in the clinic for evaluation of a murmur. Echocardiography showed rheumatic heart disease with mild mitral regurgitation and moderate aortic regurgitation; no shunts were present. Coronary and aortic root angiography did not show a vessel originating from the right coronary cusp. The right coronary artery originated from the left main coronary artery and had an aberrant course which was dorsal to the ascending aorta. No associated congenital heart disease was present.     

Anomalous origin of the left coronary artery from the right pulmonary artery associated with complex congenital heart disease

The rare coexistence of anomalous origin of the left coronary artery from the main pulmonary artery with other cardiac malformations prompts us to report an unusual case of anomalous origin of the left coronary artery from the right pulmonary artery associated with complete atrioventricular canal, patent ductus arteriosus, and coarctation of the aorta. It is important to recognize the presence of an anomalous origin of the left coronary artery in complex congenital heart disease since the coronary artery anomaly will increase the morbidity of the associated congenital cardiac malformation. Conversely, correction of the associated congenital cardiac defect may decrease the pulmonary artery pressure resulting in reduced left coronary artery flow, myocardial ischemia, and death.     

Left ventricular noncompaction with a single coronary artery of anomalous origin

Noncompaction of ventricular myocardium (NVM) is a morphogenetic anomaly of ventricular myocardium that leads to the development of cardiomyopathy. It is frequently associated with other congenital cardiac malformations. A 75-year-old woman was admitted with resting dyspnea lasting for several days. Two-dimensional echocardiography demonstrated an enlarged left ventricle with global impairment of systolic function. The myocardial trabeculations, with multiple recesses, were observed at the apex and mid-ventricular segment of the left ventricle. Contrast echocardiography showed filling of the recesses with the contrast agent. Dynamic contrast magnetic resonance imaging also showed distinctive features of NVM corresponding to the echocardiographic findings. In addition, a coronary artery originating from the proximal ascending aorta was observed. Aortogram and coronary angiography confirmed that the coronary artery had an aberrant origin from the ascending aorta and right coronary artery was an anomalous origin from left anterior descending coronary artery. This case suggests that NVM can present with other life threatening cardiovascular anomalies and different imaging studies are helpful for a comprehensive diagnosis.     

Overview of coronary artery variants,aberrations and anomalies

Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. The rapid advancement of imaging techniques, including computed tomography, magnetic resonance imaging, intravascular ultrasound and optical coherence tomography, have provided us with a wealth of new information on the subject. Anomalous origin of a coronary artery from the contralateral sinus is the anomaly most frequently associated with sudden cardiac death, in particular if the anomalous coronary artery has a course between the aorta and the pulmonary artery. However, other coronary anomalies, like anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae, have also been implicated in cases of sudden cardiac death. Patients are usually asymptomatic, and in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure and myocardial infarction may occur. The aims of this article are to present a brief overview of the diverse coronary variants and anomalies, focusing especially on anatomical features, clinical manifestations, risk of sudden cardiac death and pathophysiologic mechanism of symptoms, as well as to provide valuable information regarding diagnostic workup, follow-up, therapeutic choices and timing of surgical treatment.     

Left main coronary trunk connecting into right atrium with an aneurysmal coronary artery fistula

Congenital coronary artery fistula (CAF) is an infrequent vascular anomaly that establishes a direct link between an epicardial coronary artery and a cardiac chamber, major vessels, or other vascular structures. In this case there was an aneurysmal-CAF between a left main trunk and the right atrium, which was initially diagnosed as a Kawasaki disease by transthoracic echocardiography and subsequently confirmed by coronary angiography and multi-slice CT angiography. A multi-slice CT angiography might well become the modality of choice for the characterization of these rare congenital anomalies.     

Congenital circumflex coronary arteriovenous fistula with aneurysmal termination in the pulmonary artery

Coronary arteriovenous fistula is a rare congenital anomaly that is seen in 0.1 % to 0.2% of coronary angiograms. Aneurysmal formation in the fistula is even rarer. We report a case of congenital circumflex arteriovenous fistula with aneurysmal formation just near its termination in the pulmonary artery, associated with atherosclerotic left anterior descending coronary artery. The anomaly was successfully repaired.     

Single right coronary artery with absence of the left main coronary artery,left anterior descending artery,and circumflex artery

Single coronary artery is an extremely rare congenital coronary anomaly in which the entire coronary arterial system arises from a solitary ostium. The Lipton's classification is used for single coronary artery anomalies. Herein, we present a 72‐year‐old woman with single coronary artery anomaly admitted with atypical chest pain. Coronary angiography and multidetector computed tomography coronary angiography findings were shared.     

Acute coronary syndrome in a patient with a single coronary artery arising from the right sinus of Valsalva: a case report

Coronary anomalies can involve origin or distribution of the artery. Most of these anomalies are not clinically important. A single coronary artery arising from the right coronary sinus of Valsalva is an extremely rare anatomic anomaly. Usually coronary artery malformation is associated with other cardiac malformations and the diagnosis is made after birth. More rarely, coronary artery anomalies are an isolated and asymptomatic cardiac malformation.     

Isolated single left coronary artery

Single coronary artery is an extremely rare congenital anomaly with a very low incidence in the general population. We present a 65-year-old woman with atypical chest pain and a single left coronary artery discovered in the cath lab. No coronary lesions were found. Such anomaly has been previously described before only in twelve patients.     

Spontaneous acquired left descending coronary artery to left ventricle fistula in a patient with an apical saddle thrombus.

Coronary artery fistulas are a rare anomaly. The majority are congenital in origin, although they may be acquired due to invasive cardiac procedures or trauma. The most common course is between the right coronary artery and the right ventricle. The authors describe the case of an acquired left anterior descending coronary artery to left ventricle fistula, associated with a saddle thrombus, in a patient with a previously normal coronary angiogram and none of the predisposing factors mentioned above. Spontaneous formation of acquired coronary fistulas is reported as a very rare event in the literature.     

Variant angina pectoris caused by coronary artery spasm

A 58 year old man presented with Prinzmetal's variant angina. Recurrent ventricular tachyarrhythmias, uncontrolled by various medical regimens, prompted cardiac catheterization. At catheterization a congenital anomaly of the coronary circulation was demonstrated, consisting of a single coronary artery. During coronary angiography, arterial spasm occurred associated with chest pain and ventricular ectopic beats. This was relieved by the acute administration of sublingual nitrates. Subsequently, despite the frequent administration of nitroglycerin and isosorbide dinitrate, chest pain and ventricular tachycardia continued to occur sporadically. Because of this, saphenous vein bypass surgery was performed. After an initial symptom-free interval, the chest pain recurred. Recatheterization revealed complete occlusion of the distal circumflex artery at the insertion of the implanted saphenous vein. The use of aortocoronary saphenous vein bypass grafting for relief of symptomatic coronary arterial spasm is questioned.     

Primary congenital anomalies of the coronary arteries: a coronary arteriographic study in Western Turkey

Coronary artery anomalies are found in 0.6% to 1.5% of coronary angiograms. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery. We reviewed the database of the Cardiac Catheterization Laboratory of Uludag Medical University in Bursa, Turkey. All patients who were subjected to coronary angiography from 1994 to 2001 were included. The study included 12,059 patients who underwent diagnostic coronary arteriography during the 8 year period. One hundred patients had primary congenital coronary anomalies. Ninty-five (95%) of the patients had anomalies of origin and distribution while five (5%) had coronary artery fistulae. The left main coronary artery (LMCA) was the most common anomalous vessel involved (forty-eight (48%) of the patients). An LMCA distribution anomaly was observed in these 48 patients. An anomalous right coronary artery (RCA) was the second most common anomaly, seen in twenty-two (22%) of the patients. An anomalous circumflex artery (Cx) was the third most common anomaly, seen in seventeen. Five patients had a coronary artery fistulae. The fistulae in our series were small without significant shunt circulation. Primary congenital coronary anomalies are isolated lesions and generally have no relation with other congenital heart diseases. They do not appear to be associated with an increased risk for development of coronary atherosclerosis. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery.     

A new diagnostic method for woven coronary artery

Woven coronary artery is an extremely rare and not clearly defined congenital malformation in which the epicardial coronary artery is divided into multiple thin channels. These multiple channels merge again into a normal conduit. This anomaly is a benign condition because there is normal blood flow after the anomalous segment of the abnormal coronary artery. We describe a woven coronary artery anomaly in the left anterior descending artery (LAD) and its first diagonal (DI) branch causing myocardial infarction that was confused with coronary dissection. The definitive diagnosis was made by optical coherence tomography (OCT). Although woven coronary is a benign anomaly, it may cause myocardial infarction. We used the novel method of OCT for the definitive diagnosis and appropriate treatment of this anomaly.     

Surviving sudden cardiac death secondary to anomalous left coronary artery from the pulmonary artery: A case report and literature review

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an uncommon type of congenital coronary anomaly. In adults, the clinical picture of ALCAPA varies widely between being asymptomatic, presenting similarly to other heart diseases, or as malignant arrhythmias. Patients who have cardiac arrest are usually young and do not exhibit prior warning symptoms. In this article we describe a case of a 22-year-old healthy male, who experienced cardiac arrest during exertion. He was then diagnosed with ALCAPA, which was surgically corrected.     

Percutaneous coronary intervention in a patient with single coronary artery

Coronary artery anomalies are found in 1–5% of all coronary angiograms. Single coronary artery is a rare congenital anomaly. The prevalence of the anomaly is 0.024–0.066% of the general population and percutaneous coronary intervention in this anomaly is performed infrequently. The highest incidence of this condition is reported from India. We report a case of a 55 year old patient of anterior wall ST elevation myocardial infarction with L1 group of single coronary artery who underwent successful angioplasty and stenting to left anterior descending artery. The unique features and inherent risks of percutaneous coronary intervention to single coronary artery are discussed.