Patients with varying courses of single coronary artery: case series. Issue 10 (3rd September 2021)

• Record Type: Journal Article
• Authors: Sheng, Calvin C; Ghobrial, Joanna; Cho, Leslie
• Editors: Krupickova, Sylvia; Ahmed, Rizwan; Puricelli, Filippo; Tindale, Alexander; Djahit, Ayse
• Is Part Of: European heart journal. Volume 5:Issue 10(2021)
• Publication Date: 2021-09-03
• Subjects: Case report -- Single coronary artery -- Anomalous aortic origin of coronary artery -- Interarterial course; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytab314
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Single coronary artery (SCA) is a rare congenital anomaly where blood to the heart is supplied through a common trunk. Identifying these abnormalities is important because some variants can compromise myocardial blood flow and increase risk of sudden cardiac death. Case summary: We present five patients with varying Lipton Group I and Group II SCA subtypes, corroborated on multi-imaging modalities and evaluated with comprehensive non-invasive as well as invasive testing. Their clinical presentations also vary from a spectrum of asymptomatic finding to angina equivalent. The decision for definitive surgical intervention involving unroofing of the involved vessel depends largely on symptoms and evidence of myocardial ischaemia. Discussion: While SCA findings are often incidental and benign, understanding the origin, branching pattern, and course of the anomalous artery has implications in prognosis and treatment. This usually involves a combination of anatomic assessment with imaging such as coronary Computed Tomography Angiography (CTA), Magnetic Resonance Angiography (MRA), and/or coronary angiography as well as functional assessment with invasive testing using tools like instantaneous wave-free ratio and intravascular ultrasound both at rest and with stress. Individualized treatment plans can then be made through a multidisciplinary approach involving adult congenital heart disease specialists and congenital cardiothoracic surgeons.