Complex single ostium coronary artery from the right coronary sinus with unique course of anomalous left circumflex coronary artery
Yukitaka Shizukuda1,2, Elsayed Abo-Salem1, Tarek Helmy1,2
1Division of Cardiovascular Health and Disease, Department of Internal Medicine University of Cincinnati, Cincinnati, OH, USA.
Insights
Single ostium coronary artery, a rare anomaly, requires careful evaluation in chest pain patients. Coronary CT angiography is crucial for characterizing complex cases like the unique Lipton R-III variation presented.
Area of Science:
- Cardiology
- Radiology
- Anatomical Variations
Background:
- Single ostium coronary artery is a rare congenital anomaly, occurring in approximately 0.0448% of cases undergoing invasive coronary angiography.
- This anomaly can present with serious clinical manifestations including angina, arrhythmias, and sudden cardiac death, necessitating its exclusion in patients with chest pain.
Purpose of the Study:
- To report a rare case of a unique Lipton classification R-III single ostium coronary artery.
- To highlight the role of coronary computed tomography (CT) angiography in delineating complex coronary artery anomalies.
Main Methods:
- Case report of a 68-year-old male presenting with chest pain.
- Invasive coronary angiography to identify the anomaly.
- Coronary CT angiography to further characterize the complex anatomy.
Main Results:
- A rare Lipton R-III single ostium coronary artery was identified.
- The anomaly involved a retroaortic and intramyocardial course of the left circumflex artery with atypical branching patterns.
- This specific anatomical variation has not been previously reported in medical literature.
Conclusions:
- Single ostium coronary artery is a clinically significant anomaly that warrants consideration in patients with chest pain.
- While invasive angiography can detect the anomaly, coronary CT angiography is essential for detailed anatomical characterization.
- Tailored clinical management based on precise anatomical details is crucial for patients with this rare coronary anomaly.
Abstract:
Single ostium coronary artery is a rare coronary artery anomaly. It is reported to occur in only 0.0448% of cases who underwent invasive coronary angiography. It can be associated with angina, arrhythmias, and possibly sudden death and is a clinically important entity to rule out in patients presenting with chest pain. We report the case of a 68-year old man who presented with worsening resting chest pain and underwent invasive coronary angiography and a single ostium coronary artery was identified. Subsequent coronary computed tomography (CT) angiography revealed it to be a unique variation of class R-III of Lipton classification of single ostium coronary artery. Lipton R-III single ostium coronary artery is rare and its incidence is reported to be 0.004% in patients who had invasive coronary angiography. In our case, anomalous left coronary circumflex artery was retroaortic course combined with intramyocardial course. It also divided into multiple obtuse marginal branches in the myocardium and never coursed along the anterior and lateral aspects of the arterioventricular groove. This variation has not been reported in the literature. Coronary CT angiography played an essential role to delineate this complex coronary anomaly. <Learning objective: Single ostium coronary artery is a rare coronary artery anomaly. However, it is a clinically important entity to rule out in the evaluation of patients with chest pain. Invasive coronary angiography can identify this anomaly; however, coronary computed tomography angiography is recommended to fully characterize this condition as demonstrated in our case. Depending on the detailed anatomical information of the anomaly, the clinical management needs to be tailored for these cases.>.
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