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Single coronary arteries: two cases with distinct and previously undescribed angiographic patterns
F S Brito1, C B Vianna, A M Caixeta
1Department of Interventional Cardiology, Heart Institute, Rua Oscar Freire 1234, apto. 101 Jd. America CEP: 01426-000, Sao Paulo, SP, Brazil. fsbrito@usp.br
Insights
Single coronary artery, a rare congenital anomaly, can cause myocardial ischemia. This study details two new variants of single right coronary arteries, explaining their unique ischemic mechanisms.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Vascular Anomalies
Background:
- Single coronary artery (SCA) is a rare congenital anomaly.
- SCA can be associated with myocardial ischemia.
- Understanding SCA variants is crucial for diagnosis and management.
Observation:
- Presents two symptomatic patients with documented myocardial ischemia.
- Details distinct and previously undescribed patterns of single right coronary arteries.
- Identifies new variants within R-I and R-II-A classifications.
Findings:
- Hypothesizes insufficient blood supply due to long arterial trajectories and underdeveloped vessels as primary ischemia mechanisms.
- Reports a unique case of coronary artery fistula (LCX to left ventricle) as an additional ischemic determinant.
- Highlights novel anatomical variations in SCA.
Implications:
- Expands the classification of single coronary artery variants.
- Provides insights into the pathophysiology of myocardial ischemia in SCA.
- Emphasizes the need for detailed angiographic assessment in suspected SCA cases.
Abstract:
Single coronary artery is a rare congenital anomaly, sometimes associated with myocardial ischemia. We present the clinical and angiographic features of two symptomatic patients with documented myocardial ischemia and with distinct and previously undescribed patterns of single right coronary arteries. These cases are new variants of the types R-I and R-II-A, in which the most probable mechanisms of ischemia are the insufficient blood supply, due to the long trajectories of the single arteries and the presence of underdeveloped vessels. Also, our second case presented with a fistulae from the LCX to the left ventricle, which is another determinant of myocardial ischemia.