Single ostium
coronary artery is a rare
coronary artery anomaly. It is reported to occur in only 0.0448%
of cases who underwent invasive
coronary angiography. It can be associated with angina, arrhythmias, and possibly sudden death and is a clinically important entity to rule out in patients presenting with chest pain. We report
the case
of a 68-year old man who presented with worsening resting chest pain and underwent invasive
coronary angiography and a single ostium
coronary artery was identified. Subsequent
coronary computed tomography (CT) angiography revealed it to be a unique variation
of class R-III
of Lipton classification
of single ostium
coronary artery. Lipton R-III single ostium
coronary artery is rare and its incidence is reported to be 0.004% in patients who had invasive
coronary angiography. In our case, anomalous
left coronary circumflex artery was retroaortic course combined with intramyocardial course. It also divided into multiple obtuse marginal
branches in
the myocardium and never coursed along
the anterior and lateral aspects
of the arterioventricular groove. This variation has not been reported in
the literature. Coronary CT angiography played an essential role to delineate this complex
coronary anomaly.
<Learning objective: Single ostium coronary artery is a rare coronary artery anomaly. However, it is a clinically important entity to rule out in the evaluation of patients with chest pain. Invasive coronary angiography can identify this anomaly; however, coronary computed tomography angiography is recommended to fully characterize this condition as demonstrated in our case. Depending on the detailed anatomical information of the anomaly, the clinical management needs to be tailored for these cases.>