Cover Image: Single coronary artery
Marc Dewey1, Jürgen Scholze2, and Patrik Rogalla1
1Department of Radiology and 2Department of Medicine, Outpatient Centre, Charité, Medical School, Freie Universität und Humboldt-Universität zu Berlin, Germany
A 61-year-old man with onset of atypical angina pectoris was referred to our institution to rule out coronary heart disease. He had no cardiovascular risk factors other than arterial hypertension; ECG and exercise ECG were both negative. We performed non-invasive coronary angiography using multislice computed tomography (0.5 mm slice width, 120 ms acquisition window). Volume-rendered reconstructions of this examination revealed no significant stenoses in the left coronary artery system (Panels A and B). The left coronary artery originated from the left anterior sinus of Valsava while there was no coronary artery arising from the right sinus of Valsalva (arrow on Panel C). The circumflex artery crossed the base of the heart to the right side and ran retrograde in the right atrioventricular sulcus (Panel D). Thus, in this case, the circumflex artery supplied the myocardial territory of the right coronary artery and the entire coronary artery tree originated from a single aortic ostium (type LI single coronary artery according to the Lipton classfication). This so-called single coronary artery is a rare coronary anomaly (prevalence of 0.066% among patients undergoing angiography) that assumes haemodynamic significance when coronary stenoses are present or a major branch passes between the aorta and the right ventricular outflow tract.
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