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[Single coronary artery arising from the right coronary sinus. Report of two cases]
A Benslimane1, F Funck, M Bellorini
1Service de cardiologie, centre hospitalier René-Dubos, Pontoise.
Insights
This study presents two cases of single coronary artery originating from the right sinus, a rare congenital condition. Surgical revascularization proved effective for patients experiencing angina and myocardial ischemia.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Single coronary artery is a rare congenital anomaly, historically diagnosed post-mortem but now identified via coronary angiography.
- This condition occurs equally from the right and left coronary sinuses.
Observation:
- Two patients presented with angina and reversible myocardial ischemia confirmed by exercise Thallium scintigraphy.
- Coronary angiography revealed a single coronary artery originating from the right coronary sinus in both cases.
- One patient had severe stenosis, and the other had occlusion of the right coronary artery.
Findings:
- Single coronary artery from the right sinus may be more frequently linked to atherosclerosis than dual coronary systems.
- Proximal atherosclerotic lesions in a single coronary artery pose a high risk.
- Surgical revascularization yielded positive outcomes for both patients.
Implications:
- Early diagnosis and intervention are crucial for managing symptomatic single coronary artery disease.
- Revascularization is recommended solely when myocardial ischemia is evident.
- Understanding the association between single coronary artery and atherosclerosis can guide clinical management.
Abstract:
The authors report two cases of single coronary artery arising from the right coronary sinus. Both patients had angina with reversible myocardial ischaemia on exercise Thallium scintigraphy. Coronary angiography showed single coronary artery arising from the right coronary sinus in both cases with severe stenosis of the right coronary artery in the first and occlusion of the right coronary artery in the second patient. Both underwent surgical revascularisation with a good result. Single coronary artery is a rare congenital abnormality (approximately 0.36 per 1,000) diagnosed at autopsy until 1963, and thereafter at coronary angiography. A review of the literature shows that an equal number of single coronary arteries arise from the right as from the left coronary sinus: there does not seem to be an increased risk of complication when a branch runs between the aorta and pulmonary artery. On the other hand, single coronary arteries arising from the right coronary sinus seem to be more commonly associated with atherosclerosis than a network with two coronary arteries, but when the lesions are proximal, the risk is high. Revascularisation is indicated only when myocardial ischaemia has been documented.