Single coronary artery type R III-C imaged by 64 slice spiral computed tomography

Abstract

Single coronary artery (SCA) is a rare coronary anomaly occurring in 0.024-0.066% of the population. Lipton and Yamanaka [1,2] have proposed an angiographic classification based on the origin of the SCA, the distribution of the main branches and the course of the anomalous arteries which can be, as far the position of the aorta and the pulmonary artery is concerned, anterior, posterior, in between, or with a combined course. In terms of clinical outcome, a main trunk or a left anterior descending artery (LAD) running between the aorta and the pulmonary artery predisposes to myocardial ischemia and sudden death usually during or immediately after exercise because of multiple factors such as compression, a slit-like origin and/or an intramural course of the LAD [3,4]. We present for the first time, to our knowledge, a case of an SCA, type R-III C, imaged by spiral computed tomography (CT) (General Electric VCT, 64 slices/ rotation scanner; General Electric Milwaukee, Wisconsin, USA) (Figs 1-4) performed in a 70-year-old man without a history of ischemic heart disease. The coronary computed angiography was indicated by the vascular surgeons (aortic aneurism surgical repair) to rule out the presence of significant coronary stenoses. Images in cardiovascular medicineFig. 1The volume rendering reconstruction (75% R to R ECG interval reconstruction), antero-posterior view, shows that the left anterior descending artery runs initially behind the pulmonary artery; the distal part of the LAD runs normally in the interventricular groove. LAD, left anterior descending artery; RCA, right coronary artery. Fig. 2The volume rendering reconstruction (75% RR interval reconstruction), after removing the pulmonary artery, shows that the course of the LAD is anterior to the aorta and posterior to the pulmonary artery; the first, second and third parts of the RCA run in the atrioventricular groove, as usual. LAD, left anterior descending artery; RCA, right coronary artery; RVB, right ventricle branch; SCAT, main trunk of the single coronary artery.

Coronary-to-bronchial artery fistula in a patient with multivessel coronary disease treated by percutaneous coronary intervention

“…This case outlines the high diagnostic accuracy of 64-MDCT both in the assessment of native circulation and in the diagnosis of coronary anomalies [11]. Angiography of the right coronary artery showing a severe stenosis in the proximal segment (arrow) and the coronary-to-bronchial anastomotic vessel (arrow).…”