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