Single coronary artery with retroaortic course. An unusual origin of right Valsalva sinus.

B of the coronary arteries may vary in origin, distribution, number, and size. Congenital anomalies of the coronary arteries occur in 0.2-1.2% of the general population.1 Most coronary artery anomalies do not cause myocardial ischemia and are often found incidentally during angiographic evaluation for other cardiac diseases. These pathologic anomalies may be present from early infancy and can result in angina, congestive heart failure, myocardial infarction, cardiomyopathy, ventricular aneurysms, or sudden death. Anatomical anomalies of the coronary arteries may lead to incorrect diagnosis of vascular insufficiency. In emergency situations, such a mistake may give rise to inappropriate decisions concerning further therapy. Coronary anomalies may also contribute to atypical presentations of myocardial infarction on echocardiography. Normal and anomalous coronary arteries have been classified by various criteria. The system proposed by Angelini1 in 1989 includes nomenclature, and definitions of both normal variations in coronary arteries and anomalous coronary arteries. A consensus report by the Society of Thoracic Surgeons–Congenital Heart Surgery Database Committee uses the following nomenclature to define coronary artery anomalies: 1. anomalous pulmonary origins of the coronaries, 2. anomalous aortic origins of the coronaries, 3. congenital atresia of the left main coronary artery, 4. coronary arteriovenous fistulae, 5. coronary artery bridging, 6. coronary artery aneurysms, and 7. coronary stenosis.2 Single coronary arteries (SCA) subtype R (right) or L (left), group I-II-III, A (anterior) or P (posterior) constitute single coronary arteries with an anterior or posterior route to the aorta and can produce myocardial ischemia,3 in the authors’ experience various degrees of myocardial ischemia may be observed when the SCA becomes insufficient to support the total myocardial burden. In addition, abnormalities of the course of coronary vessels may also cause problems in cases of emergency treatment. A 42-year-old woman with stable angina was presented to the Cardiac Catheterization Center, Cardiology Department, Dicle University, Turkey. The patient had a history of chest pain on exertion and dyspnea occurring over 3-4 months. The pain was located on the left side of her chest with radiation to the left arm. Occasionally, the patient had sweating, stable angina and syncope. Physical exam, baseline electrocardiogram, electrocardiogram Holter, and x-ray results were normal. But, treadmill (Electrocardiogram) test was positive. Coronary angiography was subsequently accomplished utilizing a 6F Judkins catheter to cannulate a single, ectopic ostium. In result, it showed a single coronary artery, and there was no evidence of any coronary stenosis. The single coronary artery arose at the level of the right sinus of Valsalva with a retroaortic course (Figure 1). The artery then divided into a left and right coronary artery. The branches had a normal terminal distribution. The patient was discharged from the hospital after administration of verapamil, atorvastatin and aspirin. Angiographic recognition of anomalies of the coronary tree is important for appropriate diagnosis and management of patients with atherosclerotic coronary diseases and in those undergoing open heart surgery. Failure to identify these anomalies can lead to inadequate and prolonged procedures which can result in catastrophic complications. Single coronary artery may occur with (41%) or without (59%) associated congenital anomalies.3 Lipton et al3 categorized numerous variations based on the site of origin (right or left coronary cusp), number of branching vessels, and course in regards to the ascending aorta and pulmonary outflow tract. Harikrishnan et Clinical Notes