A rare case of single right coronary artery with congenital absence of left coronary artery in an adult: a case report

Abstract

Single right coronary artery with congenital absence of left coronary artery is one of the rarest coronary artery anomalies. Most coronary anomalies are asymptomatic and incidental findings. We report a case of single right coronary artery with congenital absence of left coronary artery detected by coronary CT angiography. Physical examination revealed a well-nourished female with a blood pressure of 130/75 mmHg and a pulse rate of 56 beats per minute. The myocardial enzymes and blood lipid levels showed normal findings. The dynamic electrocardiogram revealed frequent ventricular premature beats. Dual-source CT angiography was performed for evaluation of coronary artery. The imaging showed a very large single coronary artery arising from the right coronary sinus of Valsalva, and demonstrated absence of the left coronary artery. Meanwhile, the findings were confirmed by coronary angiography.

Computed tomography coronary angiography diagnosis of single right coronary artery with congenital absence of left coronary artery system equivalents

“…Only three prior such cases have been documented to date in literature two on necropsy[ 4 ] and a third on dual source CT coronary angiogram by Fu et al . [ 5 ] Notably enough, none of these reports had MVP as an association. Nonetheless, there exists report indicative of genetic propensity of MVP associated with the congenital coronary anomaly.…”

“…[ 6 ] The present coronary anomaly is at significant variance with Lipton's classification; therefore, precludes categorization into any of the types described by Lipton et al ., thus forming the basis for classification as a new subtype of R1 of Lipton's classification as proposed by Fu et al . [ 5 ] The associated MVP makes already rare entity more noteworthy. An extensive literature search revealed yet another classification, by Shirani and Roberts,[ 4 ] albeit least quoted and acknowledged, but indeed in reckoning the most comprehensive classification of single coronary anomalies and among others includes the presence or absence of equivalent arteries of one of the absent main coronary artery as criteria.…”

“…Coronary CT angiography remains an unparalleled noninvasive imaging modality in congenital coronary anomalies and categorically demonstrates their origin, course, branches, and termination. [ 8 9 ] The coronary anomaly with atypical characteristics reported upon represents a possible yet undescribed subtype of Lipton's Type R1[ 5 ] or Shirani's Type IIa and the association with MVP has not documented earlier.…”

“…Single anatomic RCA with superdominant branches and absent equivalents of the left coronary artery system is the rarest of the coronary artery anomalies with only three cases reported hitherto, two on necropsy,[ 4 ] and third on dual source computed tomography (CT) coronary angiography. [ 5 ] Significantly enough, none of these reported cases indicate associated MVP. The association with MVP makes the present entity (not documented in above-cited publications) at significant variance with single RCA anomalies, reported to date, and therefore notable.…”

Single right coronary artery with right ventricular fistula and congenital absence of left coronary artery: an extremely rare combination

“…2 Single anatomic right coronary artery with the absent equivalents of the left coronary artery system is an extremely rare coronary artery anomaly with only a few adult cases reported hitherto. [3][4][5] The clinical significance of coronary anomalies depends on their potential to cause myocardial ischemia and sudden death, which in turn is dependent on their origin, course, and associated CHDs. Here we reported an extremely rare case who has a combination of single coronary artery, coronary artery fistula, and absence of equivalents of the left coronary artery system.…”