Single coronary artery originating from the right coronary sinus presented with chronic total occlusion: A case
Xhevdet Krasniqi1, Aurora Bakalli1, Valon Morina2
1Medical Faculty, University of Prishtina, Kosovo; University Clinical Center of Kosova, Kosovo.
Insights
A rare single coronary artery (SCA) anomaly with a retro-aortic left anterior descending artery (LAD) course requires precise diagnosis. Coronary computed tomography angiography (CCTA) is crucial for evaluating anatomical risks and guiding treatment for this potentially life-threatening condition.
Area of Science:
- Cardiovascular Imaging
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Single coronary artery (SCA) is a rare congenital anomaly where one artery arises from a single coronary sinus, branching into the main coronary arteries.
- The anomalous origin, particularly from the right coronary sinus, can lead to various aberrant courses of the left anterior descending artery (LAD).
- Assessing the anatomical course and associated coronary artery disease (CAD) is vital for treatment planning.
Observation:
- This case details a rare instance of SCA originating from the right coronary sinus with a retro-aortic LAD course.
- Coronary angiography (CA) identified the SCA and an occluded right coronary artery (RCA) with chronic total occlusion (CTO).
- Coronary computed tomography angiography (CCTA) precisely delineated the retro-aortic LAD course and confirmed the SCA.
Findings:
- CCTA is superior to CA for detailed three-dimensional visualization of coronary artery anomalies (CAAs) and surrounding structures.
- Identifying the specific retro-aortic course of the LAD in SCA is critical due to potential life-threatening implications.
- The presence of SCA and CTO necessitates consideration of CTO recanalization or cardiac surgery for refractory angina.
Implications:
- Accurate diagnosis of SCA, especially with complex LAD courses, is essential for risk stratification and management.
- CCTA has become the gold standard for diagnosing CAAs, enabling better identification of malignant variants.
- Treatment strategies for SCA with CAD must be individualized based on anatomical complexity and disease severity.
Introduction And Importance:
A single coronary artery (SCA) is a rare congenital anomaly in which the artery originates from either the left or right coronary sinus. Shortly after its origin, the SCA branches into the right coronary artery (RCA), the left anterior descending artery (LAD), and the left circumflex artery (LCx). When the SCA originates from the right coronary sinus, the LAD may follow one of several abnormal courses, including the posterior atrioventricular groove, retro-aortic, interarterial, intraseptal, prepulmonic, or posterior-anterior interventricular groove. Assessing the anatomical risk and the presence of concomitant coronary artery disease (CAD) in the anomalous vessel is essential for determining the appropriate treatment.
Case Presentation:
We present a very rare case of a retro-aortic LAD course originating from SCA of the right coronary sinus in a patient admitted to our clinic for evaluation of chest pain. Coronary angiography (CA) of the right coronary system revealed a SCA. RCA was occluded, with chronic total occlusion (CTO). Coronary computed tomography angiography (CCTA) was done to specify the course of LAD, which showed a SCA and a posterior course around the aorta of LAD.
Clinical Discussion:
CA is a valuable tool to identify and classify coronary artery anomalies (CAAs), but due to invasiveness, low spatial resolution, and lack of three-dimensional images, it has been progressively replaced by CCTA. CCTA is the gold standard for diagnosis of the CAAs that enabling three-dimensional visualization of the surrounding cardiac and non-cardiac structures identify patients with malignant CAAs. Taking into account the presence of SCA and CTO, the treatment option is recanalization of CTO or cardiac surgery if refractory angina is present.
Conclusion:
When the SCA originates from the right coronary sinus, identifying the abnormal course of the LAD is critical, as it may be life-threatening. Alongside CA, CCTA plays a key role in evaluating the anatomy and associated risks of this anomaly. The appropriate treatment is determined based on the presence and severity of concomitant CAD.
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