Single coronary artery--a rarity in the catheterization laboratory: case report and current review

Area of Science:

• Cardiology
• Medical Imaging
• Anatomical Pathology

Background:

• A single coronary artery is a rare congenital anomaly.
• This condition has been linked to potentially fatal outcomes, including sudden cardiac death.
• Understanding its anatomical variations is critical for diagnosis and management.

Observation:

• A case study of a 73-year-old man presenting with atypical chest pain and exercise-induced ischemia is detailed.
• The patient had a single coronary artery anomaly where the left main coronary stem originated from the proximal right coronary artery.
• The anomalous artery followed a retroaortic path, posing diagnostic challenges for conventional coronary angiography.

Findings:

• Contrast-enhanced electron beam tomography provided a clear three-dimensional visualization of the anomalous coronary artery's course.
• Hypotheses for myocardial ischemia and sudden death in this anomaly focus on the acute angle at the origin and compromised coronary blood flow.
• Coronary spasm and hypoplasia are also considered contributing factors.

Implications:

• Accurate anatomical delineation using advanced imaging is vital for diagnosing and managing single coronary artery anomalies.
• Understanding the mechanisms of ischemia in anomalous coronary arteries can guide therapeutic strategies.
• This case highlights the importance of considering rare coronary anomalies in patients with unexplained cardiac symptoms.