Single coronary artery: anomalous origin of right coronary artery from the left anterior descending artery

Abstract

DESCRIPTIONWe are presenting an interesting case of a single coronary artery in a patient presenting with an acute coronary event. A 33-year-old man presented with an acute anterior wall myocardial infarction and was lysed with streptokinase. He subsequently underwent coronary angiography which revealed the presence of only a single coronary artery.The left main coronary artery (LMCA) was dividing into the left anterior descending (LAD) and the left circumflex coronary artery (LCX) and there was a left dominant circulation (figure 1). Interestingly, there was an anomalous origin of the right coronary artery (RCA) from the proximal LAD which had a proximal stenosis of around 60-70% severity at its origin (figures 1-3). The finding was also confirmed by an aortic root angiogram (figure 4). The case was planned for conservative treatment because the patient was asymptomatic and there was no evidence of any ischaemia in the inferior wall territory. Conservative treatment was also justified in this case as the lesion was not critical and was present in a non-dominant artery. The patient also had a thrombus containing lesion in the LMCA, proximal LAD and LCX which was managed conservatively with intravenous glycoprotein IIb-IIIa inhibitor infusion. The lesion was predominantly thrombus containing with less atheromatous quotient with good antegrade flow as was confirmed in other views. Hence, stent deployment in this lesion was not considered for fear of thrombus migration and no-reflow phenomenon leading to a fresh infarct in a patient who was presently asymptomatic.Congenital anomalies of coronary arteries are very rare and usually documented as an incidental finding during routine catheter or CT angiograms