A Rare Coronary Anomaly: Single Coronary Artery; Two Cases

Year 2025, Volume: 9 Issue: 1, 82 - 86, 01.04.2025

Selçuk Ayhan , Cemal Köseoğlu , Can Ramazan Öncel

Abstract

We present two cases of a rare coronary anomaly—single coronary artery—identified incidentally during routine coronary angiography. Both patients presented with symptoms of chest pain and exertional angina. In both cases, the anomaly is located in the right sinus of Valsalva (R-1-A) and crosses the heart anterior to the right ventricle. (Figure 3) The first patient experienced significant stenosis in the proximal left anterior descending artery, which was successfully treated with percutaneous stent implantation. The second patient's chest pain was managed effectively with medical therapy alone. These cases highlight that a single coronary artery, often asymptomatic, can exist as a congenital anomaly in patients experiencing myocardial ischemia due to atherosclerotic coronary artery disease. Furthermore, they demonstrate that percutaneous coronary intervention, including stent placement, offers a promising treatment approach. In the literature, coronary artery bypass surgery should particularly be considered as a treatment option for these coronary anomalies. However, it has also been shown that in selected cases, percutaneous intervention or medical therapy can be viable alternatives.

Keywords

coronary angiography, coronary artery anomalies, single coronary artery, chest pain

Nadir Bir Koroner Anomali: Tek Koroner Arter; İki Olgu

Abstract

Bu makalede, rutin koroner anjiyografi esnasında rastlantısal olarak keşfedilen iki tek koroner arter anomalisi vakası anlatılmaktadır. Hastaların semptomları arasında, eforla tetiklenen göğüs ağrısı ve anjina bulunmaktadır. Her iki olguda da anomali, sağ Valsalva sinüsünde (R-1-A) yer almaktadır ve sağ ventrikül önünden kalbi çaprazlamaktadır (Şekil -3). İlk hastanın proksimal sol ön inen arterinde ciddi bir darlık saptanmış ve bu darlık, perkütan stent implantasyonu ile etkin bir şekilde tedavi edilmiştir. İkinci hastanın göğüs ağrısı ise medikal tedavi ile giderilmiştir. Bu olgular, aterosklerotik koroner arter hastalığı sonucu miyokardiyal iskemi yaşayan kişilerde, sessiz bir konjenital koroner arter anomalisi olarak tek koroner arterin bulunabileceğini ve stent implantasyonu ile perkütan koroner müdahalenin uygun bir tedavi yöntemi olabileceğini ortaya koymaktadır. Bu koroner anomalilerde literatürde bypass cerrahisi tedavi seçeneği olarak özellikle akılda tutulmalı ancak seçilmiş vakalarda perkütan girişim veya medikal tedavinin de seçenek olabildiği gösterilmiştir.

Keywords

Koroner Anjiyografi, Koroner Arter Anomalileri, Tek Koroner Arter, Göğüs Ağrısı

References

• 1. Elbadawi A, Baig B, Elgendy IY, Alotaki E, Mohamed AH, Barssoum K, Fries D, Khan M, Khouzam RN. Single Coronary Artery Anomaly: A Case Report and Review of Literature. Cardiol Ther. 2018;7(1):119-23. doi: 10.1007/s40119-018-0103-4.
• 2. Dündar C, Çakal S, Tigen K, Kırma C. Single Coronary Artery: A Case Report. Koşuyolu Heart Journal. 2011;14(1):21-3
• 3. Sahin DY, Bozkurt A. Anomalous single coronary artery presenting as typical angina pectoris: a case report. Turk Kardiyol Dern Ars. 2010;38(2):121-4. PMID: 20473016.
• 4. Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology. 1979;130(1):39-47. doi: 10.1148/130.1.39.
• 5. Raddino R, Pedrinazzi C, Zanini G, Leonzi O, Robba D, Chieppa F, et al. Percutaneous coronary angioplasty in a patient with an anomalous single coronary artery arising from the right sinus of Valsalva. Int J Cardiol. 2006;112(3):e60-2. doi: 10.1016/j.ijcard.2006.02.032.
• 6. Mirchandani S, Phoon CK. Management of anomalous coronary arteries arising from the contralateral sinus. Int J Cardiol. 2005;102(3):383-9. doi: 10.1016/j.ijcard.2004.10.010.
• 7. Canbay A, Ozcan O, Aydoğdu S, Diker E. Single coronary artery anomaly: a report of three cases. Turk Kardiyol Dern Ars. 2008;36(7):473-5. PMID: 19155663.