Type Of Single Coronary Artery Research Articles

The Right Type of Single Coronary Artery

The Right Type of Single Coronary Artery

P54 RIGHT SINGLE CORONARY ARTERY AS AN INCIDENTAL FINDING IN ACUTE PERICARDIAL DISEASE

Abstract An 44–year–old woman was referred to our hospital for chest pain. She had no known cardiovascular risk factors but had a history of previous acute pericarditis following pregnancy. At admission, she still had chest pain improved by leaning forward. Cardiovascular examination and her electrocardiogram showed nothing pathological. On laboratory tests, there were mild elevation of troponin T and normal C–reactive protein. A transthoracic echocardiogram revealed only a minimal pericardial effusion close to the right heart chambers. A chest X–ray was generally normal. She was admitted to the coronary care unit with a provisional diagnosis of myopericarditis. Three days later, due to the persistence of symptoms despite the appropriate pharmacological therapy, it was decided to perform coronary angiography. During the procedure, selective cannulation of the left coronary artery was not possible, and a non–selective injection disclosed no coronary artery arising from the left coronary sinus. On selective injection of the right coronary sinus, a single ostium was visualized. The right coronary artery (RCA) was a great vessel, with no stenosis. A left anterior descending artery (LAD) and left circumflex artery (LCx) were perfused from RCA collateral vessels, both without lesions. Coronary computed tomography angiography confirmed a single coronary artery with its ostium in the right sinus of Valsalva and agenesis of the left main artery (LCA). A physical stress echo ruled out inducible myocardial ischemia. Coronary artery anomalies are rare congenital disorders that are usually diagnosed incidentally. Single coronary artery (SCA) has been known since 1903. It is an anomalous condition in which the SCA originates from a single aortic orifice, either the left or the right aortic ostium, and gives rise to the entire coronary circulation. Isolated congenital SCA is a very rare condition, occurring in 0.024–0.098% of the general population. Right SCA with congenital absence of the LCA is the least common type of SCA, and is extremely rare with a reported incidence of 0.0008%. SCA has been reported in association with atherosclerotic disease, coronary artery fistulas, mitral valve prolapse, bicuspid aortic valves, tetralogy of Fallot, transposition of the great arteries, hypertrophic cardiomyopathy and Takotsubo syndrome. We report this extremely rare case because the concomitant association with pericardial diseases has never previously been reported.

Clinical outcome according to spasm type of single coronary artery provoked by intracoronary ergonovine tests in patients without significant organic stenosis.

This study aimed to evaluate clinical implications of single vessel coronary spasm provoked by intracoronary ergonovine provocation test in Korean population. A total of 1248 patients who presented with single vessel coronary artery spasm induced by intracoronary ergonovine provocation test, excluding 1712 with negative spasms, multiple and mixed coronary artery spasms and missing data among 2960 patients in the VA-KOREA (Vasospastic Angina in Korea) registry, were classified into diffuse (n=705) and focal (n=543) groups. The 24-month incidences of a composite primary endpoints (cardiac death, new-onset arrhythmia, and acute coronary syndrome) were determined. Over a median follow-up of 30months, the composite primary end point occurred more frequently in the focal type patients than in the diffuse type patients (primary endpoint: adjusted hazard ratio [aHR], 1.658; 95% confidence interval [CI] 1.272 to 2.162, P<0.001). Especially, unstable angina in ACS components played a major role in this effect (hazard ratio [HR], 2.365; 95% confidence interval [CI] 1.100 to 5.087, P=0.028). Focal type of single vessel coronary artery spasm in vasospastic angina (VSA) patients is found to be associated with worse clinical outcomes. It is thought that the effect is stemmed from unstable angina among ACS rather than the other components of primary endpoint. Therefore, focal type of single vessel coronary artery spasm in patients with VSA should be more carefully assessed and managed with appropriate medication.

TCTAP A-101 Clinical Implication According to Spasm Type of Single Coronary Artery Provoked by Intracoronary Ergonovine Tests in Korean Patients

TCTAP A-101 Clinical Implication According to Spasm Type of Single Coronary Artery Provoked by Intracoronary Ergonovine Tests in Korean Patients

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.

Percutaneous coronary intervention in a rare variety of single coronary artery

We present a case of 50-year-old male having unstable angina. A rare type of single coronary artery was identified during the Coronary angiogram. The left anterior descending (LAD) and left circumflex artery (LCX) had originated from the proximal segment of right coronary artery along with significant lesion in LCX. Computed tomographic (CT) coronary angiogram confirmed the origin and course following which successful percutaneous coronary intervention (PCI) was done to LCX. The incidence of this type of coronary anomaly is 0.004%. We emphasize the importance of having a CT coronary angiogram to identify the course before the intervention. The procedural risk during PCI in patients with single coronary ostium is high. Moreover, the angulation and course of the culprit artery also pose a challenge. Good coaxial guide support by using an appropriate guiding catheter is the key to success.

A rare case of ‘superdominant’ single coronary artery

A 45 year male patient with no risk factors and no associated cardiac anomaly presented to us with exertional chest pain since 10 years. During coronary angiography, we were unable to intubate the left main coronary artery. Cannulation of the right coronary ostium showed a 'superdominant' Right coronary artery, which initially followed the course of the normal right coronary artery, then proceeded via a posterolateral segment into the course of the normal left circumflex artery, and finally followed the course of the normal left anterior descending artery (Images 1–3).CT coronary angiogram confirmed the findings (Images4–5). Intramyocardial bridging was also seen which explained the angina.This subtype is named type R-IA according to Lipton's classification and is by far the most rare type of single coronary artery with an incidence of 0.0008%. Some patients may present with myocardial ischemia or stable angina. The exact mechanism is unknown but may be related to intramyocardial bridging or coursing of epicardial arteries between great arteries.

A rare type of single coronary artery with right coronary artery originating from the left circumflex artery in a child.

The presence of a single coronary artery is a rare congenital anomaly; such patients often present with severe myocardial ischemia. We experienced the case of a 13-year-old girl with the right coronary artery originating from the left circumflex artery. She visited our Emergency Department owing to severe chest pain; her cardiac enzyme levels were elevated, but her initial electrocardiogram (ECG) was normal. Echocardiography showed normal anatomy and normal regional wall motion. When she presented with recurrent chest pain on admission, the ECG showed significant ST-segment elevation in the left precordial leads and inferior leads with ST-segment depression in aVR lead, suggesting myocardial ischemia, and her cardiac enzyme levels were also elevated. We performed coronary angiography that showed a single right coronary artery originating from the left circumflex artery without stenosis. We confirmed the presence of a single coronary artery using coronary computed tomography. In addition, the treadmill test that was performed showed normal results. She was discharged from the hospital without any medications but with a recommendation of a regular follow-up.

Isolated single coronary artery (RII-B type) presenting as an inferior wall myocardial infarction: A rare clinical entity

Isolated single coronary artery without other congenital cardiac anomalies is very rare among the different variations of anomalous coronary patterns. The prognosis in patients with single coronary varies according to the anatomic distribution and associated coronary atherosclerosis. If the left main coronary artery travels between the aorta and pulmonary arteries, it may be a cause of sudden cardiac death. We present multimodality images of a single coronary artery, in which the whole coronary system originated by a single trunk from the right sinus of Valsalva with inter-arterial course of left main coronary artery. This rare type of single coronary artery was classified as RII-B type according to Lipton's scheme of classification. A significant flow-limiting lesions were found in the right coronary artery that was successfully treated with percutaneous coronary intervention.

R-IIIC type: non-simple single coronary artery

We read with great interest a report by Gallo et al. [1] on a very rare coronary artery anatomy. In a classification of single coronary artery (SCA) by Lipton et al. [2] with modifications by Yamanaka and Hobbs [3], this case refers to the R-IIIC type of SCA. Indeed, there is little discrepancy between terminology and anatomy in this type of SCA, which is very apparent in the present case. According to the foregoing classification, the R-IIIC type of SCA is an anomaly where the left anterior descending artery (LAD) and left circumflex artery (LCx) arise separately from the proximal part of the normal right coronary artery (RCA). Then, LCx passes the great vessels posteriorly and LAD crosses anteriorly the infundibulum of the right ventricle to reach their usual locations [2, 3]. This LAD supplies only the middle and distal portions of the anterior interventricular sulcus (AIVS), and the proximal portion of the AIVS receives blood from the ‘LCx’ (it is clearly seen in Fig. 2A from [1]). Thus, AIVS has two sources of blood supply and this anatomy refers to Type IV dual LAD [4]. In more detail, we have discussed this anatomy in a recent similar case by Saxena et al. [5, 6]. Hence, the R-IIIC type of SCA is a combination of two anomalies: Type IV dual LAD and left main stem (LM) originating from the RCA, and the correct description of coronary arteries in this type should apply the terms long LAD, short LAD and LM. Correct diagnosis of dual LAD in SCA may be important in planning the strategy of revascularization in the case of atherosclerotic lesions in the LM or short LAD.

Right Coronary Artery Originated from the Left Anterior Descending Artery in a Patient with Congenital Pulmonary Valvular Stenosis

The single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery, is a benign and very rare coronary artery anomaly. We firstly present a case with this type of single coronary artery and congenital pulmonary valvular stenosis with large poststenotic dilatation.

Conventional and computed tomography angiography views of a rare type of single coronary artery anomaly: right coronary artery arising from distal left circumflex artery

Conventional and computed tomography angiography views of a rare type of single coronary artery anomaly: right coronary artery arising from distal left circumflex artery

Successful coronary stenting of a rare type of single coronary artery—A case report

The case of a patient with a very rare type of single coronary artery who underwent successful primary stenting for significant right coronary artery stenosis is reported. The complication risk during percutaneous coronary intervention is increased in patients with single coronary artery but it is an effective therapeutic option in selected cases.

Single right coronary artery-R-I subtype: A report of an extremely rare case

A single coronary ostium with no associated congenital cardiac disease is a rare congenital coronary-artery anomaly. However, a single right coronary artery has a much rarer incidence. We report here the antemortem diagnosis of a case with R-I subtype single coronary artery supplying the entire myocardium. A 36-year-old female with chest pain and dyspnea on exertion was admitted to the hospital, whose coronary angiography revealed a single, large coronary artery originating in the right aortic sinus. No observable change was detected in her electrocardiogram and her angiographic examination did not reveal any significant luminal narrowing although she experienced chest pain and dyspnea on exertion. R-I type of single coronary artery is an anomaly with a very rare incidence, which may cause myocardial ischemia and sudden death and whose recognition might be of use to physicians when diagnosing and treating this anomaly.

Successful coronary stenting of a rare type of single coronary artery—A case report

The case of a patient with a very rare type of single coronary artery who underwent successful primary stenting for significant right coronary artery stenosis is reported. The complication risk during percutaneous coronary intervention is increased in patients with single coronary artery but it is an effective therapeutic option in selected cases.

Management of Transposition of the Great Arteries with Single Coronary Artery

Approximately 5% of patients with transposition of the great arteries have a single coronary artery. In the early years of the arterial switch procedure a single coronary artery was associated with an increased risk of mortality. This was particularly true for the most common type of single coronary artery in which there is a right posterior ostium giving rise to a right coronary artery that passes to the right atrioventricular groove and a left coronary artery that passes posterior to the pulmonary artery. An understanding of the mechanisms by which this coronary pattern increases the risk of mortality has led to neutralization of this risk factor. The risk of late reintervention after an arterial switch with single coronary artery is increased with a single left posterior ostium with the right coronary passing anterior to the aorta. The mechanism remains unclear.

Single coronary artery from the right sinus of Valsalva: angiography, anatomy, and clinical significance

A case of single coronary artery from the right sinus of Valsalva with a connecting branch passing between the aorta and right ventricular infundibulum is described. The anomaly was demonstrated at coronary arteriography and verified at surgery. This type of single coronary artery has been associated with sudden exertional death in young persons. The case prompted a review of the classification of single coronary artery with emphasis on clinical significance of the various subtypes and angiographic findings.