A single coronary artery is a very rare condition, commonly associated with other congenital anomalies. It could be generally classified as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches. By presenting the patient with an isolated single coronary artery, who underwent successful combined aortic valve replacement and coronary artery bypass grafting surgery, we intend to distinguish casual from causal in this extremely rare clinical and surgical scenario. This is the first-ever case published, combining such underlying pathology, clinical presentation, and surgical treatment.

Background / Aim: To determine the current state of the institutional informed consent policy before elective cardiac surgical procedures in light of actual national legislation. Methods: An anonymous, voluntary survey was conducted among 200 consecutive patients, at the Clinic for Cardiac Surgery, UC Clinical Centre of Serbia, from September to December 2019, after having signed an official institutional consent form. A targeted questionnaire was created to determine the quantity and quality of patient?s information about general and the most important aspects of cardiac surgical care. Results: The mean age of respondents was 66.2 years, with male predominance (68.0%), homogenous ethnicity, and low-to-middle (84.0%) education levels. A significant percentage had no information on the type of surgery (16.0%), extracorporeal circulation (46.0%), anaesthesia (56.0%) and transfusion (51.5%). Of those having some information, 7.0%-20.0% graded them sufficient. The worst situation was recorded concerning risks of disease and surgical treatment, where 88.0% of patients had no information and almost 90.0% having some information, graded them non-sufficient. Surprisingly, 81.5% of patients have signed the consent form without any prior discussion with the operating surgeon. For 56.0% of patients. the information in the actual consent form was clear and sufficient. While 85.5% of patients claimed the importance, the others (14.5%) were not interested to know the most relevant information about their disease and surgery. Conclusion: The results unambiguously indicate an unacceptably low level of our patients? information about the cardiac surgical procedure, extracorporeal circulation, anesthesia, transfusion, and estimated risk. The majority of them (85.5%) comprehend the importance and expect timely and adequate information. An extremely high percentage (81.5%) of patients had no chance to discuss the procedure with the operating surgeon. Both surgical indifference and insufficient knowledge of professional, ethical, and legal importance, are the most important reasons for actual informed consent policy in cardiac surgery.

A single coronary artery is a very rare condition, commonly associated with other congenital anomalies. It could be generally considered as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches. By presenting the patient who underwent successful coronary artery bypass grafting and aortic valve replacement surgery in a presence of isolated single coronary artery, we intend to emphasize natural and procedural risks and distinguish casual from causal in this extremely rare clinical and surgical scenario.