Successful primary coronary angioplasty for acute inferior myocardial infarction in a patient with RII-type single coronary artery.

To cite: Vural A, Aksoy H, Karagöz A, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014208325 DESCRIPTION A single coronary artery is a rare coronary anomaly in which only one coronary artery arises from the aortic trunk by a single ostium and supplies the entire myocardium. Although rare, reports about revascularisation of congenitally abnormal coronary vessels are present in the literature. We report a case of a 72-year-old man with previously unknown coronary anomaly presenting with acute inferior myocardial infarction. The patient was admitted to the emergency room with typical chest pain at rest for 6 h. He was diagnosed as acute inferior myocardial infarction and coronary angiography was performed immediately. The left coronary artery ostium cannulation attempt failed. The right coronary artery (RCA) was cannulated with a right Judkins-guiding catheter. In the left anterior oblique cranial projection, the whole coronary system was visualised from a single ostium, located at the right sinus of Valsalva and giving off branches to the RCA and the left coronary system (figure 1). There was a thrombotic total occlusion in the proximal-portion of the RCA. There was an arterial collateral from left coronary system to RCA, which filled the distal part of the RCA anterogradely. The lesion was crossed with a 0.014-inch guidewire and a bare metal stent (3.5×16 mm) was implanted. Stenting of the occluded branch was performed successfully (figure 2). The patient was free from chest pain and discharged uneventfully. Single coronary artery anomalies are usually benign and asymptomatic. If a patient with single coronary artery anomaly has a heart attack, routine percutaneous intervention should be performed.