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Case Reports
. 2015 Jul-Aug;67(4):389-91.
doi: 10.1016/j.ihj.2015.03.015. Epub 2015 Apr 27.

A rare case of 'superdominant' single coronary artery

Abhisekh Mohanty  1 , Sharad Chandra  2
Affiliations
Case Reports

A rare case of 'superdominant' single coronary artery

Abhisekh Mohanty et al. Indian Heart J. 2015 Jul-Aug.

Abstract

A 45 year male patient with no risk factors and no associated cardiac anomaly presented to us with exertional chest pain since 10 years. During coronary angiography, we were unable to intubate the left main coronary artery. Cannulation of the right coronary ostium showed a 'superdominant' Right coronary artery, which initially followed the course of the normal right coronary artery, then proceeded via a posterolateral segment into the course of the normal left circumflex artery, and finally followed the course of the normal left anterior descending artery (Images 1-3).CT coronary angiogram confirmed the findings (Images4-5). Intramyocardial bridging was also seen which explained the angina. This subtype is named type R-IA according to Lipton's classification and is by far the most rare type of single coronary artery with an incidence of 0.0008%. Some patients may present with myocardial ischemia or stable angina. The exact mechanism is unknown but may be related to intramyocardial bridging or coursing of epicardial arteries between great arteries.

Keywords: Coronary artery anomalies; Lipton's classification; Superdominant right coronary artery.

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Figures

Image 1
Image 1
Coronary angiogram image showing absence of left coronary ostia.
Image 2
Image 2
LAO (left anterior oblique) cranial view showing a superdominant single right coronary artery.
Image 3
Image 3
LAO cranial view showing the superdominant right coronary artery filling the left circumflex artery (LCX) retrogradely which is then filling the left anterior descending (LAD) artery antegradely.
Image 4
Image 4
CT coronary angiogram showing the absence of any direct communication of the left circumflex artery and left anterior descending artery with the aortic root.
Image 5
Image 5
CT coronary image showing the origin of a large single right coronary artery from the aortic root.
See this image and copyright information in PMC

References

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    1. Lipton M.J., Barry W.H., Obrez I. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology. 1979;130:39–47. - PubMed
    1. Echavarría-Pinto Mauro, Rodríguez-Rodríguez Engels, Macías Enrico, Kimura-Hayama Eric. Extremely rare single right coronary artery: multidetector computed tomography findings. Arch Cardiol Mex. 2012;82:195–196. - PubMed

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