Zoran Stajic a,⇑, Zdravko Mijailovic a a
Clinic of Cardiology, Military Medical Academy, Belgrade
a
Serbia
Ó 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University. Keywords: Single coronary artery, Congenital coronary artery anomaly, Bicuspid aortic valve stenosis
A
75-year-old male with history of hypertension and hypercholesterolemia, presented with recurrent chest pain. Transthoracic echocardiography revealed severe bicuspid aortic valve stenosis. Pressure gradient over the aortic valve was 152 mm Hg and 94 mm Hg, peak and mean respectively; and calculated aortic valve area (AVA) was 0.77 cm2, with concentric left ventricular hypertrophy and preserved global left ventricular systolic function (LVEF) at 65%. Coronary angiography demonstrated a single coronary artery arising from the right sinus of Valsalva (Fig. 1). The right coronary artery (RCA) was hyperdominant and it branched into the left descending coronary artery (LAD) giving rise from the distal branch of acute marginal artery, and the circumflex coronary artery (CX) giving rise from the distal branch of posterolateral artery. All branches of a single coronary artery were free
of significant atherosclerotic disease. Cardiac computed tomography was subsequently performed and it confirmed normal course of all branches (Fig. 2) as well as severe calcifications of the aortic valve (Fig. 3). The patient eventually underwent surgical aortic valve replacement with uneventful hospital outcome. Single coronary artery is an extremely rare congenital coronary artery anomaly where only one coronary artery arises from the aorta from a single coronary ostium to supply the entire heart, occurring in 0.02–0.06% of coronary angiograms [1]. Although some patterns of a single coronary artery may cause clinical manifestations of myocardial ischemia and sudden death, most cases are asymptomatic [2]. The clinical significance of a single coronary artery originating from the right sinus of Valsalva depends on its relationship with the aorta and the main pulmonary trunk [3]. The
Disclosure: Authors have nothing to disclose with regard to commercial support. Received 23 June 2013; accepted 16 July 2013. Available online 6 August 2013
⇑ Corresponding author. Address: Military Medical Academy, Clinic of Cardiology, Crnotravska 17, 11040 Belgrade, Serbia. Tel.: +381 11 266 1122x26537. E-mail address: [email protected] (Z. Stajic). URL: http://www.vma.mod.gov.rs (Z. Stajic).
P.O. Box 2925 Riyadh – 11461KSA Tel: +966 1 2520088 ext 40151 Fax: +966 1 2520718 Email: [email protected] URL: www.sha.org.sa
1016–7315 Ó 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University. Peer review under responsibility of King Saud University. URL: www.ksu.edu.sa http://dx.doi.org/10.1016/j.jsha.2013.07.002
Production and hosting by Elsevier
IMAGES IN REVIEW
Single coronary artery associated with severe bicuspid aortic valve stenosis
278
STAJIC, MIJAILOVIC SINGLE CORONARY ARTERY ASSOCIATED WITH SEVERE BICUSPID AORTIC VALVE STENOSIS
IMAGES IN REVIEW
RCA
J Saudi Heart Assoc 2013;25:277–278
LAD CX
Figure 1. Left anterior-oblique view of the coronary angiography showing single coronary artery arising from the right sinus of Valsalva, with the hyperdominant right coronary artery branching into the left ascending coronary artery and the circumflex coronary artery.
LAD RCA
CX
Figure 3. Cardiac computed tomography in the right anterior-oblique view showing severe calcifications of the aortic valve (arrow).
diagnosis and understanding of anomalies in coronary circulation are particularly important for further therapeutic decisions and management in cases with additional coronary and/or valvular heart surgery. Our patient presented two particularities: this is the oldest age at which such a diagnosis has been made. The second particularity is the combination of a single coronary artery arising from the right sinus of Valsalva associated with severe bicuspid aortic valve stenosis undergoing surgical aortic valve replacement.
References
Figure 2. Cardiac computed tomography in the left anterior-oblique view demonstrating single coronary artery with normal course arising from the right sinus of Valsalva and the origin of left anterior descending artery from acute marginal branch and the origin of circumflex artery from posterolateral branch.
[1] Desmet W, Vanhaecke J, Vrolix M, Van de Werf F, Piessens J, Willems J, et al. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J 1992;13(12):1637–40. [2] Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21(1):28–40. [3] Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35(6):1493–501.
Clinic of Cardiology, Military Medical Academy, Belgrade
a
Serbia
Ó 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University. Keywords: Single coronary artery, Congenital coronary artery anomaly, Bicuspid aortic valve stenosis
A
75-year-old male with history of hypertension and hypercholesterolemia, presented with recurrent chest pain. Transthoracic echocardiography revealed severe bicuspid aortic valve stenosis. Pressure gradient over the aortic valve was 152 mm Hg and 94 mm Hg, peak and mean respectively; and calculated aortic valve area (AVA) was 0.77 cm2, with concentric left ventricular hypertrophy and preserved global left ventricular systolic function (LVEF) at 65%. Coronary angiography demonstrated a single coronary artery arising from the right sinus of Valsalva (Fig. 1). The right coronary artery (RCA) was hyperdominant and it branched into the left descending coronary artery (LAD) giving rise from the distal branch of acute marginal artery, and the circumflex coronary artery (CX) giving rise from the distal branch of posterolateral artery. All branches of a single coronary artery were free
of significant atherosclerotic disease. Cardiac computed tomography was subsequently performed and it confirmed normal course of all branches (Fig. 2) as well as severe calcifications of the aortic valve (Fig. 3). The patient eventually underwent surgical aortic valve replacement with uneventful hospital outcome. Single coronary artery is an extremely rare congenital coronary artery anomaly where only one coronary artery arises from the aorta from a single coronary ostium to supply the entire heart, occurring in 0.02–0.06% of coronary angiograms [1]. Although some patterns of a single coronary artery may cause clinical manifestations of myocardial ischemia and sudden death, most cases are asymptomatic [2]. The clinical significance of a single coronary artery originating from the right sinus of Valsalva depends on its relationship with the aorta and the main pulmonary trunk [3]. The
Disclosure: Authors have nothing to disclose with regard to commercial support. Received 23 June 2013; accepted 16 July 2013. Available online 6 August 2013
⇑ Corresponding author. Address: Military Medical Academy, Clinic of Cardiology, Crnotravska 17, 11040 Belgrade, Serbia. Tel.: +381 11 266 1122x26537. E-mail address: [email protected] (Z. Stajic). URL: http://www.vma.mod.gov.rs (Z. Stajic).
P.O. Box 2925 Riyadh – 11461KSA Tel: +966 1 2520088 ext 40151 Fax: +966 1 2520718 Email: [email protected] URL: www.sha.org.sa
1016–7315 Ó 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University. Peer review under responsibility of King Saud University. URL: www.ksu.edu.sa http://dx.doi.org/10.1016/j.jsha.2013.07.002
Production and hosting by Elsevier
IMAGES IN REVIEW
Single coronary artery associated with severe bicuspid aortic valve stenosis
278
STAJIC, MIJAILOVIC SINGLE CORONARY ARTERY ASSOCIATED WITH SEVERE BICUSPID AORTIC VALVE STENOSIS
IMAGES IN REVIEW
RCA
J Saudi Heart Assoc 2013;25:277–278
LAD CX
Figure 1. Left anterior-oblique view of the coronary angiography showing single coronary artery arising from the right sinus of Valsalva, with the hyperdominant right coronary artery branching into the left ascending coronary artery and the circumflex coronary artery.
LAD RCA
CX
Figure 3. Cardiac computed tomography in the right anterior-oblique view showing severe calcifications of the aortic valve (arrow).
diagnosis and understanding of anomalies in coronary circulation are particularly important for further therapeutic decisions and management in cases with additional coronary and/or valvular heart surgery. Our patient presented two particularities: this is the oldest age at which such a diagnosis has been made. The second particularity is the combination of a single coronary artery arising from the right sinus of Valsalva associated with severe bicuspid aortic valve stenosis undergoing surgical aortic valve replacement.
References
Figure 2. Cardiac computed tomography in the left anterior-oblique view demonstrating single coronary artery with normal course arising from the right sinus of Valsalva and the origin of left anterior descending artery from acute marginal branch and the origin of circumflex artery from posterolateral branch.
[1] Desmet W, Vanhaecke J, Vrolix M, Van de Werf F, Piessens J, Willems J, et al. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J 1992;13(12):1637–40. [2] Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21(1):28–40. [3] Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35(6):1493–501.
