Single left coronary artery with coronary artery aneurysm and right ventricular fistula.

Resection of Giant Coronary Artery Aneurysms in a Takayasu's Arteritis Patient

Arterial switch operation with a single coronary artery.

Normal Single Coronary Artery and Myocardial Infarction

We report a rare case of a 6-year-old boy who was diagnosed with coronary artery fistulae communicating with the right ventricle and a left single coronary artery. Preoperative angiography showed a dilated and tortuous single coronary artery draining into the right ventricle. Two coronary artery fistulae draining into the right ventricle were detected at operation and both of these were ligated. Postoperative angiography showed that the single coronary artery diameter was almost normalized, although the vessel was still slightly tortuous. His clinical course was uneventful. In this report, we summarize cases of coronary artery fistula with single coronary artery that have been reported in the literature as well as our case.

A 52-year-old female presented with an acute coronary syndrome, anterior T wave inversions, and elevated cardiac markers. After cardiac catheterization, a critical mid-left anterior descending artery (LAD) stenosis involving the origin of the second diagonal branch and a critical mid-right stenosis were observed. It was felt that the “culprit” vessel was the LAD, and a successful angioplasty was performed with a drug-eluting stent (DES), Cypher (Cordis), placed in the LAD and the diagonal branch dilated with a balloon. The right coronary artery (RCA) was treated with a drug-eluting stent 3 days later (Figure 1 …

Coronary artery anomalies may induce myocardial ischaemia and sudden cardiac death when associated with areas of compression or stenosis. We present a case of transection and reimplantation of an anomalous interarterial right coronary artery arising from a single left main coronary artery. The 18-year-old collegiate athlete had exertional chest pain and haemodynamically significant compromise to coronary blood flow.

We report the case of a 66-year-old man with a left anterior descending (LAD) coronary artery aneurysm. Cigarette smoking and hepatitis C virus infection were in his clinical history. Coronary angiography performed in 2002 showed a LAD aneurysm, a 50% stenosis of the right coronary artery, and a 30% stenosis of the left main artery (Figure 1, a through c). The ECG in 2002 was normal (Figure 2b i ). In 2002, the patient underwent successful Jomed polytetrafluoroethylene (PTFE)-coated stenting (3.0×20 mm) to cover the aneurysm (Figure 1d). After stenting, the patient was discharged on ticlopidine 250 mg/d for 1 year, aspirin 100 mg/d, metoprolol 25 mg/d, and transdermal nitrates. Figure 1. LAD …

Single coronary arteries are rare congenital anomalies in which the whole heart circulation is supplied by a coronary artery arising from a single ostium. Single left coronary artery with right coronary artery (RCA) originating from distal left circumflex artery (LCX) is a very rare anomaly with only few cases reported in the literature. We report a 44 years old male presenting with anterior myocardial infarction who was found to have a single left coronary artery during angiography. RCA had an abnormal origin arising from distal of a dominant LCX that retrogradely followed the course of a normal RCA to the base of the heart. A brief review of the reported cases with emphasis on the clinical significance of this unusual anomaly is presented.

A congenital coronary artery fistula (CCAF) combined with giant coronary aneurysm (CAA) is a rare congenital cardiac abnormality. We reported an 8-year-old patient who underwent transcatheter closure of both inlet and outlet of a proximal left coronary artery (LCA)-to-left ventricular (LV) fistula with CAA of 41 mm × 28 mm in diameter, during which acute occlusion of left anterior descending coronary artery (LAD) occurred immediately after device implantation at the inlet of fistula. We managed to prevent the patient from major adverse cardiac events by conservative therapy with dual antiplatelet agents instead of surgical removal of the device. The patient recovered well and had been follow-up for 2 years with no late complications reported.

Anatomical study of a left single coronary artery with special reference to the various distribution patterns of bilateral coronary arteries

Single coronary artery (SCA) is a rare anomaly, with a reported prevalence of only 0.024% - 0.066% among patients undergoing routine coronary angiography. Most SCA is found only incidentally in conventional coronary angiography or coronary computed tomography angiography. Some subgroups of SCA can lead to angina pectoris, acute myocardial infarction, or even sudden cardiac death. We present the extremely unusual case of a patient with anteroseptal ST elevation myocardial infarction (STEMI) who was also diagnosed with SCA upon further evaluation. A 52-year-old man with a history of smoking and hypertension was referred to our hospital with an anterior ST-elevation myocardial infarction. Coronary angiography was performed immediately and demonstrated a single coronary artery arising from the left coronary sinus with an anomalous right coronary artery originating as a separate branch from the left anterior descending artery (LAD). The culprit lesion was subtotal occlusion of the proximal segment of LAD, which was recanalized and treated with drug-eluting stent angioplasty. A coronary computed tomography angiography (CCTA) showed an anomalous right coronary artery (RCA) that arose from the proximal LAD, which coursed anteriorly to the pulmonary artery to reach the territory normally served by the RCA. The distal left circumflex (LCX) coronary artery gave rise to the posterior descending and posterolateral branches. In conclussion, the RCA originating from the (LAD) is an extremely rare coronary anomaly; in such cases, the RCA arises from the proximal or mid-portion of the LAD artery. So far, only 40 cases have been reported. Enhanced awareness of congenital cardiac anomalies may help guide management.

A single left coronary artery with right coronary artery arising from either left main stem (LMS) or left anterior descending artery (LAD) or circumflex artery (Cx) is an extremely rare coronary anomaly. This is the first report of separate origins of proximal and distal RCA from LAD and circumflex arteries respectively in a patient with a single left coronary artery. This 57 year old patient presented with unstable angina and severe stenotic disease of LAD and Cx arteries and underwent urgent successful quadruple coronary artery bypass grafting. The anomalies of right coronary artery in terms of their origin, number and distribution are reviewed.

Giant Aneurysm of the Left Atrial Branch of the Left Circumflex Artery With Fistula

The case of an 8-year-old girl with a single coronary artery is presented. This vessel arose as a left coronary artery and followed the distribution of one coronary artery. The long circumflex branch traveled in the atrioventricular groove and continued as a vessel occupying the position usually held by the right coronary artery. It ended as a fistula to the outflow tract of the right ventricle. A continuous murmur was present clinically. Cardiac catheterization and selective angiocardiography demonstrated the anatomy of the lesion and the presence of a left-to-right shunt. Operation consisted of ligation of the fistula and anastomosis of the right ventricular portion of the coronary artery to the aorta with a Dacron tube graft. This latter maneuver established a dual inflow into the coronary arterial system and should overcome the disadvantage of a single coronary artery in the event that arteriosclerotic occlusive lesions develop in later life. Furthermore, the procedure demonstrated the feasibility of grafting technics that may find application in the treatment of anomalous origin of a coronary artery from the pulmonary artery.

BackgroundHypertrophic cardiomyopathy is a commonly inherited heart disease. In addition, single coronary artery (SCA) is a rarecongenital anomaly of the coronary arteries. And SCA concomitant with severehypertrophic obstructive cardiomyopathy (HOCM) has seldombeen reported in the literature. However, such caseshave not been reported to be treated with the Morrow procedure.Case presentationHerein, 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.ConclusionTo 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.