Single coronary artery originating from the right coronary sinus presented with chronic total occlusion: A case report
Year: 2025
Type: article
Study design: Case Report
Abstract: INTRODUCTION AND IMPORTANCE: A single coronary artery (SCA) is a rare congenital anomaly in which the artery originates from either the left or right coronary sinus. Shortly after its origin, the SCA branches into the right coronary artery (RCA), the left anterior descending artery (LAD), and the left circumflex artery (LCx). When the SCA originates from the right coronary sinus, the LAD may follow one of several abnormal courses, including the posterior atrioventricular groove, retro-aortic, interarterial, intraseptal, prepulmonic, or posterior-anterior interventricular groove. Assessing the anatomical risk and the presence of concomitant coronary artery disease (CAD) in the anomalous vessel is essential for determining the appropriate treatment. CASE PRESENTATION: We present a very rare case of a retro-aortic LAD course originating from SCA of the right coronary sinus in a patient admitted to our clinic for evaluation of chest pain. Coronary angiography (CA) of the right coronary system revealed a SCA. RCA was occluded, with chronic total occlusion (CTO). Coronary computed tomography angiography (CCTA) was done to specify the course of LAD, which showed a SCA and a posterior course around the aorta of LAD. CLINICAL DISCUSSION: CA is a valuable tool to identify and classify coronary artery anomalies (CAAs), but due to invasiveness, low spatial resolution, and lack of three-dimensional images, it has been progressively replaced by CCTA. CCTA is the gold standard for diagnosis of the CAAs that enabling three-dimensional visualization of the surrounding cardiac and non-cardiac structures identify patients with malignant CAAs. Taking into account the presence of SCA and CTO, the treatment option is recanalization of CTO or cardiac surgery if refractory angina is present. CONCLUSION: When the SCA originates from the right coronary sinus, identifying the abnormal course of the LAD is critical, as it may be life-threatening. Alongside CA, CCTA plays a key role in evaluating the anatomy and associated risks of this anomaly. The appropriate treatment is determined based on the presence and severity of concomitant CAD.
Authors: Xhevdet Krasniqi, Aurora Bakalli, Valon Morina, Pajazit Morina, Ramiz Qovanaj, Hajdin Çitaku
Institutions: University Clinical Center of Kosovo, University of Prishtina
Language: English
Topic: Coronary Artery Anomalies
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W4407095445