Introduction
A single coronary artery is a rare coronary anomaly in which only one coronary artery arises from the aortic trunk by a single ostium and supplies the entire myocardium. We report a case of 72 years man with previously unknown coronary anomaly who admitted to hospital for acute inferior myocardial infarction.
Case
A 72-year-old man was admitted to the emergency room with typical chest pain at rest for 6 hours. The patient’s atherosclerotic risk factors included hypertension and hyperlipidemia. He was hemodynamically stable. Physical examination revealed a blood pressure of 112/65 mmHg with a regular pulse of 64 beats per minute, and 1-2/6 apical systolic heart murmur was heard. The admission electrocardiogram showed 1-mm ST segment elevation in the inferior leads. Laboratory tests was unremarkable, except for elevated markers of myocardial necrosis (troponin I: 12,32 ng/ml). Echocardiography revealed a left ventricular ejection fraction 50% with mild hypokinesia of posterior and inferior wall and a mild mitral regurgitation. Coronary angiography was performed immediately with a diagnosis of acute inferior myocardial infarction. The left coronary artery ostium cannulation attempt was failed. The right coronary artery (RCA) was cannulated with right Judkins guiding catheter. In the left anterior oblique cranial projection, the whole coronary system is visualized from a single ostium, located at the right sinus of Valsalva and giving off branches to RCA and the left coronary system. There was a thrombotic total occlusion in the proximal-portion of the RCA. There was an arterial collateral from left coronary system to RCA which filled distal part of RCA anterogradely. The lesion was crossed with a 0.014 inch guidewire and bare metal stent (3.5×16 mm) was implanted. Stenting of the occluded branch was performed successfully. The patient was free from chest pain and discharged on the forth day with a drug regimen aspirin, clopidogrel, metoprolol and atorvastatin.
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