Single coronary artery diagnosed by multidedector computed tomography/Cok kesitli bilgisayarli tomografi ile tani konulan tek koroner arter.

The coronary circulation originating from a single coronary ostium is a rare variation. These variations were classified according to the site of the origin and distribution patterns of the coronary arteries. We describe Type IIB 4 pattern in this case. The left main coronary artery (LMCA) arised from the proximal right coronary artery and coursed to the left side anterior to the right ventricle. It gave the left anterior descending artery (LAD) coursing to the interventricular groove and left circumflex artery (CxA) coursing to the left atrioventricular groove.

A 40-year-old male presented with atypical chest pain for six month. His physical examination, laboratory results, chest X-ray, and electrocardiogram were normal. A multidedector computed tomography coronary angiography (MDCT-CA) was performed to evaluate the coronary vessels. The MDCT-CA showed a single large coronary artery originating from right sinus of Valsalva (Fig. 1, Video 1. See corresponding video/images at www.anakarder.com) and the left main coronary artery arising from proximal right coronary artery. After traversing in front of the right ventricular outflow tract, LMCA gave the origin to the LAD and CxA. There was no vessel originating from the left coronary cusp (Fig. 2). Stenosis was not observed in any part of the coronary tree. No further associated congenital heart anomaly was present.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

The incidence of isolated single coronary artery in angiographic series is 0.024%. It has a little clinical significance, except for cases in which a coronary artery traverses between the aorta and the pulmonary artery. Identification of retropulmonary position of an arterial segment is important, since mechanical compression of such a vessel between the aorta and the pulmonary artery may be a potential cause of ischemia and sudden cardiac death. The anomaly of this case has no clinical significance of this kind.

Until now, the main diagnostic method for detection of coronary anomalies has been coronary angiography which has some limitations. It is an invasive procedure and only selectively visualizes one vessel tree at a time and cannot obtain information on the 3-dimensional (3D) course of the vessel. Novel advances on computed tomography technology offer a noninvasive and accurate diagnostic modality to visualize the origin and course of anomalous coronary arteries in a 3D fashion.

Cihan Duran *, Demet Erciyes **, Mustafa Sirvanci *, Murat Sener **, Murat Gulbaran * ***

From Departments of Radiology * and Cardiology **, Florence Nightingale Hospital, *** Department of Cardiology, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey

Address for Correspondence/Yazisma adresi: Dr. Cihan Duran Radyoloji Departmani Florence Nightingale Hastanesi Abide-i Hurriyet Cad. No: 290 Sisli/Istanbul 80220, Turkey Fax: [phone]/5010 Mobile: [phone] E-mail: [e-mail]