Single Coronary Artery Anomaly Causing Chest Pain

Abstract

The "single coronary artery" anomaly arises from the aortic root by a single coronary ostium and in the absence of another ostium mostly has an asymptomatic course. However, some types of this congenital anomaly may cause various clinical manifestations like chest pain and even sudden death.In this presentation, a 51-year-old woman, who had complaints of typical chest pain increasing with hypertension was presented. Angiography was performed due to chest pain complaints, revealed that all coronary system was giving off branches from a main single coronary artery, which arose from the right sinus of valsalva. There weren't any blocking coronary lesions that might cause ischemia. Multislice computed tomography examination was performed in order to describe the symptoms and it was observed that this main coronary artery arose from right sinus of valsalva as well as it followed a retroaortic course. Because of symptoms of myocardial ischemia, further evaluation of the coronary ostium with intravascular ultrasound (IVUS) was suggested. However the patient refused further invasive examination and a medical treatment was arranged.After a month, under a medical treatment and while her blood pressure was under control, she experienced atrial fibrillation attack that had begun after typical chest pain. Medical cardioversion with sotalol was succesfull. At that time further evaluation was again suggested but the patient refused again. The patient having Canadian Cardiovascular Society (CCS) class II angina pectoris is being followed up in our clinic for the last six months without experiencing any coronary events or arrhythmia.