versão impressa ISSN 1405-9940
Arch. Cardiol. Méx. vol.82 no.2 México apr./jun. 2012
Imagen en cardiología
Extremely rare single right coronary artery: multidetector computed tomography findings
Arteria coronaria derecha única muy infrecuente: hallazgos por tomografía computada multidetector
Mauro EchavarríaPinto, Engels RodríguezRodríguez, Enrico Macías, Eric KimuraHayama.
Department of Radiology. Instituto Nacional de Cardiología Ignacio Chávez. Mexico City, Mexico.
Eric KimuraHayama, MD.
Juan Badiano # 1, Sección XVI,
Tlalpan. Z.P. 14080. Mexico City. Mexico.
Telephone: (+52) 55 5573 2911. Fax: (+52) 55 5550 1620.
Email address: email@example.com
Received on September 9, 2011.
Accepted on December 9, 2011.
Coronary anomalies are rare, with a reported prevalence of 1.3% among patients who undergo coronary angiography. The great majority of coronary artery anomalies are incidental findings and are not clinically significant, but in some cases, may be responsible for angina, syncope, arrhythmias or even sudden death. In the following case, we describe coronary CT angiography findings of one of the rarest coronary anomalies. Lipton RI type single right coronary artery has only been previously reported in very few occasions and has been seen in only 0.0007% of the population.
Keywords: Coronary anomalies; Multidetector computed tomography; Single right coronary artery; Mexico.
Las anomalías congénitas de las arterias coronarias son raras, con una prevalencia estimada de 1.3% en pacientes sometidos a angiografía coronaria. La gran mayoría de estas anomalías no son clínicamente significativas, aunque en algunos casos, pueden producir angina, síncope, arritmias e incluso muerte súbita. En el siguiente caso, describimos mediante tomografía computarizada multicorte, una de las anomalías congénitas de las arterias coronarias más raras. La arteria coronaria derecha única tipo RI de Lipton, de la que sólo se han reportado muy pocos casos y su prevalencia se estima en 0.0007%.
Palabras clave: Anomalías coronarias; Tomografía computada multicorte; Arteria coronaria derecha única; México.
A 68yo woman with systemic arterial hypertension requested medical attention because of atypical chest pain. Physical examination, cardiac biomarkers and 12lead electrocardiogram were unremarkable. A treadmill stress test showed monomorphic ventricular extrasystolia in association with atypical chest pain during early recovery phase. Finally, a coronary CT angiography performed on a 64slice scanner, showed absence of the left coronary artery and demonstrated a single coronary artery arising from the right coronary sinus of Valsalva. The right coronary artery continued its course as a left circumflex artery and ended as a left anterior descending artery (Figures 1 and 2). This unusual case of a single coronary artery anomaly (SCA) corresponds to a Lipton RI type.1 No plaques were noted and the Calcium score was 0 AU. Conservative treatment was recommended and she has being doing well during a 2year followup.
One of the rarest coronary artery anomalies is the SCA RI type of which very few cases have been reported (in a very large series, only one was found in 126 595 patients).2,3 Coronary anomalies may cause reduced regional myocardial blood flow particularly in the presence of interarterial courses or vasospasm but, in the present case, no atherosclerosis was found and the coronary course was sought to be hemodynamically benign. Even though, we encourage close follow up, as obstruction of a SCA could be catastrophic. Nowadays, MDCT allows noninvasive, multiplanar and accurate assessment of coronary arteries and should be coronary anomalies diagnostic reference method.
Conflict of interest
Dr. Eric KimuraHayama is Advisor of the Imaging Solutions Advisory Board (ISAB) of Covidien. The rest of coauthors have no conflict of interest.
1. Lipton MJ, Barry WH, Obrez I, et al. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology 1979;130: 3947. [ Links ]
2. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990;21:2840. [ Links ]
3. Desmet W, Vanhaecke J, Vrolix M, et al. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J 1992;13:16371640. [ Links ]