Successful primary percutaneous coronary intervention in a patient with acute myocardial infarction and single coronary artery ostium

Abstract

One of the single anomalous origins of coronary artery that has rarely been reported is a congenital anomaly of coronary circulation that occurs in the left coronary artery originating from the right coronary sinus of valsalva. We report a 49-year-old male patient with non-ST segment elevated myocardial infarction that was identified to have an anomalous origin of the left coronary artery from the right coronary artery (RCA) with thrombotic total occlusion of RCA by coronary angiography and cardiac computed tomography. The patient underwent successful percutaneous coronary intervention in total occlusion of the RCA and was discharged after uneventful recovery.

Keywords: Coronary vessel anomalies; Myocardial infarction; Percutaneous transluminal coronary angioplasty.

Fig. 1

An electrocardiogram shows ST segment elevation in aVR, and V 1-2, and ST segment depression in II, III, aVF and V 4-6.

Fig. 2

Coronary angiogram demonstrated anomalous origin of left coronary arteries and right ventricular branch communicating between proximal right coronary artery and middle left anterior descending coronary artery (A). Right coronary angiogram revealed thrombotic total occlusion (arrow) in proximal right coronary artery (B). After primary percutaneous coronary intervention using multiple thrombosuction and intracoronary stenting, right coronary artery showed good distal flow (C).

Fig. 3

Cardiac computed tomogram scan demonstrated single origin of coronary artery from right coronary sinus of valsalva with communication between right coronary artery and middle left anterior descending coronary artery via the right ventricular branch.

Fig. 4

One week later, we performed follow-up coronary angiogram using Amplatz right 2 cm curve guiding catheter, coronary angiogram revealed patent stent in proximal right coronary artery and more resolved state of thrombi in the posterior descending artery, and improved distal flow in the posterior lateral branch.