Isolated Single Right Coronary Artery in a Young Patient: A Rare Shirani-Roberts Type IIC3

In 1993, Shirani and Roberts classified single coronary arteries into 20 categories on the basis of the location of the coronary ostium and artery path. Many, but not all, of these types of single coronary arteries have been described since.

An 18-year-old female patient presented initially with exertional dyspnea and later with tachycardia. Echocardiography revealed a dilated right coronary artery. Computed tomography angiography and selective coronary angiography revealed a single right coronary artery originating from the right sinus of Valsalva, with a rudimentary left anterior descending arising proximally. The circumflex artery and the remainder of the left anterior descending territory are supplied by collateral vessels, and there is evidence of decreased perfusion. The patient was started on aspirin and restricted from competitive athletics.

Single coronary arteries are rare congenital anomalies that have the potential for serious consequences, including sudden cardiac arrest and death. This study presents the youngest patient reported to have a Shirani-Roberts type IIC3 single right coronary artery.

This case highlights the difficult management considerations and significant potential consequences of this anomaly.