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[Three cases of single coronary artery]
Insights
Single coronary artery, once considered minor, can cause serious complications like angina and myocardial infarction. This report details three complex cases, highlighting the anomaly's significant clinical importance.
Area of Science:
- Cardiology
- Congenital Heart Disease
Background:
- Single coronary artery (SCA) is a rare congenital anomaly.
- Historically underestimated, SCA is increasingly recognized for potential complications.
Observation:
- Three patients with SCA (Smith's type 2) presented with diverse complications.
- Case 1: 56-year-old female with angina, 90% left circumflex artery stenosis.
- Case 2: 48-year-old male with chest pain/syncope, 75% right coronary artery stenosis.
- Case 3: 69-year-old male with chest pain, no significant stenosis.
Findings:
- SCA can be associated with significant coronary artery stenosis.
- Complications include angina, myocardial infarction, and arrhythmia.
- Percutaneous coronary intervention (PCI) may improve outcomes in select cases.
Implications:
- SCA requires careful evaluation due to its potential for severe cardiovascular events.
- Early diagnosis and management are crucial for preventing adverse outcomes.
- This highlights the importance of recognizing SCA in patients with unexplained cardiac symptoms.
Abstract:
Single coronary artery has been considered a minor coronary anomaly without clinical importance. With the wide spread of coronary angiography, however, the disease has been reported to develop complications at a high rate, such as angina, myocardial infarction and arrhythmia. We report three patients with single coronary artery with several complications. Case 1: A 56-year-old woman having a past history of diabetes mellitus and myocardial infarction was admitted because of the recently developed frequent attacks of effort angina. Treadmill test was positive and thallium-201 exercise myocardial scintigraphy revealed redistribution in the lateral wall. Ascending aortogram suggested that the right coronary artery (RCA) arose from the left sinus of Valsalva. An injection into the right sinus of Valsalva revealed no coronary ostium. Selective left coronary angiogram resulted in the diagnosis of single coronary artery (Smith's type 2) with 90% stenosis in the left circumflex artery (LCX). Left ventriculogram showed hypokinesis in the anterolateral wall. PTCA performed on this patient revealed clinical and nucleomedical improvement. Case 2: A 48-year-old man experienced chest pain and syncope. Electrocardiogram revealed ST-elevations in II, I and a VF, sinus bradycardia and atrioventricular junctional rhythm. Angiography resulted in the diagnosis of single coronary artery (Smith's type 2) with 75% stenosis in the RCA. Ergonovine test was positive. Case 3: A 69-year-old man complained of chest pain. Electrocardiogram showed complete right bundle branch block, sinus bradycardia and atrioventricular junctional rhythm. Cardiac catheterization revealed that this was also a case of single coronary artery (Smith's type 2) with no significant stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)