Isolated single coronary artery with dual right coronary artery distribution. A rare anatomical variation

Area of Science:

• Cardiovascular Medicine
• Anatomical Variants
• Interventional Cardiology

Background:

• Coronary artery anomalies are rare but can have significant clinical implications.
• Single coronary artery (SCA) is a rare anomaly where only one coronary artery arises from the aorta.
• Understanding coronary artery variations is crucial for accurate diagnosis and treatment of cardiovascular diseases.

Observation:

• A 76-year-old patient with non-ST-segment elevation myocardial infarction presented with an unusual isolated single coronary artery (SCA).
• The SCA exhibited a dual right coronary artery (RCA) distribution: one RCA originated from the left anterior descending (LAD) artery with a prepulmonic course, and the second RCA extended from the left circumflex artery.
• This case is unique as it represents the second reported instance of this specific SCA combination and the first with a single LAD-derived RCA branch.

Findings:

• The LAD-derived RCA originated as a single branch, a previously unreported variation.
• The sinus node artery originated from this ectopic LAD-connected RCA, another novel finding.
• This anatomical pattern is exceptionally rare, with only one prior report of the combined SCA variants.

Implications:

• This rare coronary artery pattern necessitates careful consideration during coronary angiography and cardiac interventions.
• Accurate identification of such anomalies is vital to prevent misdiagnosis and ensure appropriate management of patients.
• The findings underscore the importance of detailed anatomical assessment in cardiovascular medicine, particularly in cases of myocardial infarction with unusual coronary anatomy.