Case Report
 
Coronary artery conundrum: A single coronary artery with origin of the right coronary artery from the distal left circumflex artery
Michael A. DiPietro1, George Stoupakis2
1MS-IV, St. George’s University School of Medicine, Grenada, West Indies
2MD, FACC, Department of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey

Article ID: 100909Z01MD2018
doi: 10.5348/100909Z01MD2018CR

Corresponding Author:
George Stoupakis, MD,
Department of Cardiology,
Hackensack University Medical Center,
30 Prospect Avenue, Hackensack, NJ 07601

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How to cite this article
DiPietro MA, Stoupakis G. Coronary artery conundrum: A single coronary artery with origin of the right coronary artery from the distal left circumflex artery. Int J Case Rep Images 2018;9:100909Z01MD2018.


ABSTRACT

Introduction: Single coronary artery with an anomalous origin of the right coronary artery arising from the distal portion of the left circumflex artery is a very rare angiographic finding. The incidence has been reported as 0.014–0.066% in the general population.

Case Report: An 81-year-old female who presented with an acute non-ST segment elevation myocardial infarction due to a coronary lesion in the first obtuse marginal branch, but who surprisingly was found to have this rare congenital coronary anomaly. Coronary angiography in this patient revealed a single coronary artery arising from the left coronary sinus. The left anterior descending and the left circumflex arteries were in normal position with a significant stenosis in the first obtuse marginal branch. The left circumflex artery was the dominant vessel that coursed beyond the left atrio-ventricular groove, giving rise to a large branch that traversed the territory normally occupied by the right coronary artery. This rare coronary anomaly was not the cause of this patient’s angina as she presented with an occlusive lesion in the first obtuse marginal branch.

Conclusion: Ischemia related to single coronary artery are reported, however, most cases are asymptomatic in the absence of an obstructive lesion.

Keywords: Anomalous right coronary artery, Coronary artery anomalies, Coronary angiography, Myocardial infarction, Single coronary artery


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Author Contributions
Michael A. DiPietro – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
George Stoupakis – Substantial contributions to conception and design, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Michael A. DiPietro et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.