"Single Coronary Artery" from Right Sinus-Uncommon Causes of Ischemia with Non-Obstructive Coronary Arteries
Paweł Muszyński1, Marlena Święcicka1, Dominika Musiałowska1
1Department of Cardiology, Lipidology and Internal Diseases, Medical University of Bialystok, Żurawia 14, 15-569 Bialystok, Poland.
Insights
Coronary artery anomalies, though rare, require prompt imaging for detection. Angio-CT effectively identifies these conditions, guiding appropriate management strategies for patients with congenital heart variations.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Congenital anomalies of coronary artery origins are uncommon but clinically significant.
- Early diagnosis via imaging is vital for preventing adverse cardiovascular events.
- Management strategies are tailored to anomaly type and severity, ranging from medication to surgical intervention.
Purpose of the Study:
- To highlight the diagnostic utility of Angio-CT in identifying coronary artery anomalies.
- To present case studies illustrating different types of coronary artery anomalies and their management.
- To emphasize the importance of advanced imaging in the evaluation of these rare conditions.
Main Methods:
- Review of two patient cases with distinct coronary artery anomalies.
- Utilized Computed Tomography Angiography (Angio-CT) for detailed anatomical assessment.
- Corroborated findings with clinical presentation, exercise testing, and myocardial perfusion scintigraphy where applicable.
Main Results:
- Case 1: A 22-year-old male with syncope presented with an undeveloped left main coronary artery (LMCA), supplied retrogradely by the right coronary artery (RCA).
- Case 2: A 77-year-old female with stenocardia showed a congenital absence of LMCA, with the left coronary artery (LCA) originating from the RCA.
- Both cases underscore the capability of Angio-CT in delineating complex coronary artery origins.
Conclusions:
- Angio-CT is a powerful imaging modality for the accurate detection and characterization of coronary artery anomalies.
- Management decisions for coronary artery anomalies are individualized based on imaging findings and clinical context.
- Continued vigilance and advanced imaging are essential for optimizing patient outcomes in cases of coronary artery anomalies.
Abstract:
Anomalies of coronary artery origins are rare but significant conditions that can range from benign to life-threatening. Early detection through imaging is crucial in preventing adverse outcomes. The treatment strategy varies depending on the type and severity of the anomaly, ranging from pharmacological treatment to surgery. A 22-year-old male patient, after syncope, after excluding other causes, had an exercise drill test, which was clinically negative and ECG-positive. Angio-CT revealed an undeveloped left main coronary artery (LMCA), and the circulation was supplied through the right coronary artery (RCA). The RCA provides the left anterior descending artery (LAD), and the LAD retrogradely supplies the left circumflex artery (LCX). The myocardial perfusion scintigraphy showed a slight lack of perfusion in the anterior wall (6% of total perfusion). The patient was qualified for further observation. A 77-year-old female underwent cardiac CT due to stenocardia. CT showed a lack of LMCA. The initial segment of the RCA gave rise to the left coronary artery (LCA), which encircled the aortic bulb posteriorly and bifurcated into branches resembling the LCX and LAD. After the Heart Team consultation, the patient was deemed eligible for conservative treatment. Angio-CT is a valuable tool for detecting coronary artery anomalies.
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