Right sided single coronary artery origin: surgical interventions without clinical consequences

Area of Science:

• Cardiology
• Anesthesiology

Background:

• Congenital coronary artery anomalies are rare, often discovered incidentally.
• Anomalous origin of the left main stem (LMS) from the right coronary artery is exceptionally uncommon.

Observation:

• A 68-year-old woman presented with atypical chest pain, necessitating anesthesia risk assessment.
• Diagnostic tests revealed mild myocardial ischemia.
• Coronary angiography and CT aortography identified a single origin of the left coronary artery with the right coronary artery and a retro-aortic course.

Findings:

• The patient had an extremely rare coronary anomaly: left main stem originating from the right coronary artery with a retro-aortic course.
• No flow-limiting lesions were present in the coronary arteries.
• The patient tolerated multiple surgical procedures under general anesthesia, utilizing various anesthetic agents, without adverse events.

Implications:

• This case demonstrates the feasibility of managing patients with rare coronary anomalies undergoing extensive surgical procedures.
• Anesthesia can be safely administered to patients with this specific congenital coronary anomaly.
• Successful surgical outcomes are achievable in patients with complex coronary anatomy when carefully managed.