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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2010; 37(4): 490–491.
PMCID: PMC2929851

Single Coronary Artery Originating from the Right Coronary Sinus

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin St., Suite 2480, Houston, TX 77030

A 50-year-old hypertensive man presented with a 2-year history of intermittent atypical angina. He had no other risk factors for coronary artery disease. Results of a chest radiograph were normal. Electrocardiography revealed sinus rhythm and no ischemic changes. Transthoracic echocardiography showed a normal left ventricular ejection fraction. Physical examination of the cardiovascular and respiratory systems revealed normal results. The patient underwent coronary angiography, which showed no vessel originating from the left coronary sinus. The right coronary artery originated from the right coronary sinus. The left anterior descending coronary artery, which gave rise to the circumflex artery, filled in a retrograde manner from the distal part of the right coronary artery (Figs. 1, ,2,2, and and33).

figure 22FF1
Fig. 1 Coronary angiogram shows that the right coronary artery (RCA) originates from the right coronary sinus. The left anterior descending coronary artery (LAD), which gives rise to the circumflex artery (LCx), fills in a retrograde manner from the distal ...
figure 22FF2
Fig. 2 Coronary angiogram shows the left anterior descending coronary artery (LAD), which gives rise to the circumflex artery (LCx).
figure 22FF3
Fig. 3 Aortogram shows the ostium of the single coronary artery (arrow).

Comment

Single coronary artery (SCA) is a rare congenital anomaly of the coronary arteries wherein only 1 coronary artery arises from the aortic trunk from a single coronary ostium and supplies the entire heart.1 The condition occurs in 0.024% to 0.066% of the population.2 Until 1950, no more than 45 cases of SCA had been reported, and all had been discovered at autopsy.3 In 1967, the 1st antemortem diagnosis was made by means of conventional coronary angiography.4 Eckart and colleagues5 found coronary anomalies in more than 30% of sudden nontraumatic deaths in young people. The prognosis in SCA is unclear, and there are no guidelines for treatment of the condition. Revascularization is recommended only if there is substantial atherosclerosis and documented ischemia.6 Hence, medical therapy—including antihypertensive, antihyperlipidemic, and antithrombotic agents—were strongly recommended to our patient, together with annual coronary angiographic follow-up examinations.

Supplementary Material

Video for Fig. 2:
Video for Fig. 3:

Footnotes

Address for reprints: Adem Ilkay Diken, MD, Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Sihhiye, 06100 Ankara, Turkey

E-mail: moc.liamg@yaklimeda

References

1. Romagnoli A, Pellegrino L, Massaro M, Patrei A, De Angelis B, Ciccio C, et al. Single coronary artery arising from right aortic sinus in a symptomatic patient. Eur J Radiol Extra 2008;65(2):55–60.
2. Braun MU, Stolte D, Rauwolf T, Strasser RH. Single coronary artery with anomalous origin from the right sinus Valsalva. Clin Res Cardiol 2006;95(2):119–21. [PubMed]
3. Smith JC. Review of single coronary artery with report of 2 cases. Circulation 1950;1(5):1168–75. [PubMed]
4. Halperin IC, Penny JL, Kennedy RJ. Single coronary artery. Antemortem diagnosis in a patient with congestive heart failure. Am J Cardiol 1967;19(3):424–7. [PubMed]
5. Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004;141(11):829–34. [PubMed]
6. Corbett M, Powers J, King S, Quinn M, Harris D. Single coronary artery. J Am Coll Cardiol 2009;53(5);455. [PubMed]

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