- Email: [email protected]
A rare case of ‘superdominant’ single coronary artery
i n d i a n h e a r t j o u r n a l 6 7 ( 2 0 1 5 ) 3 8 9 e3 9 1
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/ihj
Images in Cardiology
A rare case of ‘superdominant’ single coronary artery Abhisekh Mohanty a,*, Sharad Chandra b a b
Senior Resident, Department of Cardiology, King George Medical University, Lucknow, India Professor, Department of Cardiology, King George Medical University, Lucknow, India
article info
abstract
Article history:
A 45 year male patient with no risk factors and no associated cardiac anomaly presented to
Received 9 April 2014
us with exertional chest pain since 10 years. During coronary angiography, we were unable
Accepted 29 March 2015
to intubate the left main coronary artery. Cannulation of the right coronary ostium showed
Available online 27 April 2015
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
Keywords:
normal left circumflex artery, and finally followed the course of the normal left anterior
Superdominant right
descending artery (Images 1e3).CT coronary angiogram confirmed the findings (Images4
coronary artery
e5). Intramyocardial bridging was also seen which explained the angina.
Lipton's classification Coronary artery anomalies
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. Copyright © 2015, Cardiological Society of India. All rights reserved.
A 45 year male patient with no risk factors and no associated cardiac anomaly presented to us with exertional chest pain since 10 years. When we did a coronary angiogram of the patient, 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 1e3).CT
coronary angiogram confirmed the findings (Images 4e5). Intramyocardial bridging was also seen which probably explains 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%.1e3 It is usually an isolated anomaly. 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.
* Corresponding author. Duplex no. 21, Suraj Vihar, Bargada Brit Colony, Brahmeshwarpatna, Bhubaneswar, Odisha 751018, India. Tel.: þ91 9005052611. E-mail address: [email protected] (A. Mohanty). http://dx.doi.org/10.1016/j.ihj.2015.03.015 0019-4832/Copyright © 2015, Cardiological Society of India. All rights reserved.
390
i n d i a n h e a r t j o u r n a l 6 7 ( 2 0 1 5 ) 3 8 9 e3 9 1
Image 1 e Coronary angiogram image showing absence of left coronary ostia.
Image 2 e LAO (left anterior oblique) cranial view showing a superdominant single right coronary artery.
Image 3 e 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 e CT coronary angiogram showing the absence of any direct communication of the left circumflex artery and left anterior descending artery with the aortic root.
i n d i a n h e a r t j o u r n a l 6 7 ( 2 0 1 5 ) 3 8 9 e3 9 1
391
Conflicts of interest The authors have none to declare.
references
1. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990;21:28e40. 2. Lipton MJ, Barry WH, Obrez I. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology. 1979;130:39e47. 3. Echavarrı´a-Pinto Mauro, Rodrı´guez-Rodrı´guez Engels, Macı´as Enrico, Kimura-Hayama Eric. Extremely rare single right coronary artery: multidetector computed tomography findings. Arch Cardiol Mex. 2012;82:195e196.
Image 5 e CT coronary image showing the origin of a large single right coronary artery from the aortic root.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/ihj
Images in Cardiology
A rare case of ‘superdominant’ single coronary artery Abhisekh Mohanty a,*, Sharad Chandra b a b
Senior Resident, Department of Cardiology, King George Medical University, Lucknow, India Professor, Department of Cardiology, King George Medical University, Lucknow, India
article info
abstract
Article history:
A 45 year male patient with no risk factors and no associated cardiac anomaly presented to
Received 9 April 2014
us with exertional chest pain since 10 years. During coronary angiography, we were unable
Accepted 29 March 2015
to intubate the left main coronary artery. Cannulation of the right coronary ostium showed
Available online 27 April 2015
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
Keywords:
normal left circumflex artery, and finally followed the course of the normal left anterior
Superdominant right
descending artery (Images 1e3).CT coronary angiogram confirmed the findings (Images4
coronary artery
e5). Intramyocardial bridging was also seen which explained the angina.
Lipton's classification Coronary artery anomalies
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. Copyright © 2015, Cardiological Society of India. All rights reserved.
A 45 year male patient with no risk factors and no associated cardiac anomaly presented to us with exertional chest pain since 10 years. When we did a coronary angiogram of the patient, 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 1e3).CT
coronary angiogram confirmed the findings (Images 4e5). Intramyocardial bridging was also seen which probably explains 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%.1e3 It is usually an isolated anomaly. 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.
* Corresponding author. Duplex no. 21, Suraj Vihar, Bargada Brit Colony, Brahmeshwarpatna, Bhubaneswar, Odisha 751018, India. Tel.: þ91 9005052611. E-mail address: [email protected] (A. Mohanty). http://dx.doi.org/10.1016/j.ihj.2015.03.015 0019-4832/Copyright © 2015, Cardiological Society of India. All rights reserved.
390
i n d i a n h e a r t j o u r n a l 6 7 ( 2 0 1 5 ) 3 8 9 e3 9 1
Image 1 e Coronary angiogram image showing absence of left coronary ostia.
Image 2 e LAO (left anterior oblique) cranial view showing a superdominant single right coronary artery.
Image 3 e 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 e CT coronary angiogram showing the absence of any direct communication of the left circumflex artery and left anterior descending artery with the aortic root.
i n d i a n h e a r t j o u r n a l 6 7 ( 2 0 1 5 ) 3 8 9 e3 9 1
391
Conflicts of interest The authors have none to declare.
references
1. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990;21:28e40. 2. Lipton MJ, Barry WH, Obrez I. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology. 1979;130:39e47. 3. Echavarrı´a-Pinto Mauro, Rodrı´guez-Rodrı´guez Engels, Macı´as Enrico, Kimura-Hayama Eric. Extremely rare single right coronary artery: multidetector computed tomography findings. Arch Cardiol Mex. 2012;82:195e196.
Image 5 e CT coronary image showing the origin of a large single right coronary artery from the aortic root.