Single Origin Coronary Artery Anomaly

Single coronary artery (SCA) is an extremely rare anomaly where all coronary vessels originate from a single ostium, supplying the entire heart. In most cases, patients are asymptomatic, and the diagnosis is often made incidentally during coronary angiography. However, symptoms such as typical chest pain, sudden cardiac death related to decreased myocardial perfusion, syncope, myocardial infarction, etc., can occur, especially during physical activity[3]. The diagnosis can be confirmed not only by coronary angiography but also by CT angiography and cardiac MRI. While CT angiography is a non-invasive imaging method, it is performed with the use of contrast agents. Cardiac MRI, on the other hand, allows for the evaluation of cardiovascular anatomy, perfusion, and function without exposure to ionizing radiation[4].

The gold standard remains coronary angiography (CAG), but due to their non-invasive nature, CT angiography and cardiac MRI have become increasingly used in recent times. Identifying the exact course of anomalous coronary vessels in relation to the aorta and pulmonary artery is crucial, as myocardial ischemia during physical activity can occur due to the bending or compression of the anomalous SCA branches between the aorta and pulmonary artery.

Treatment options include conservative management, percutaneous coronary intervention (PCI), and surgical intervention. Although the prognosis for individuals with SCA remains uncertain, the majority of major adverse cardiac events occur in 15% of patients before the age of 40. Asymptomatic patients typically do not require treatment and should be managed with strict control of risk factors. In cases with multiple anatomical anomalies or in symptomatic patients, a multidisciplinary approach, including cardiothoracic surgery and invasive interventions, may be considered.

The presence of atherosclerotic coronary artery disease (CAD) in patients with coronary anomalies is particularly significant when deciding between PCI and coronary artery bypass grafting (CABG). Understanding the potential variations in coronary anatomy, their different origins, and courses is vital for both diagnostic and therapeutic purposes. Symptomatic patients with significant CAD can be treated with routine interventions like PCI or CABG[5]. Pre-surgical identification of coronary anomalies is also of great importance, as complications may arise during surgery, such as misidentifying or damaging an anomalous vessel during cardiopulmonary bypass.

Lipton[6] initially proposed an angiographic classification of SCA, which was later modified by Yamanaka. This classification takes into account the origin of the ostium from the sinus of Valsalva and the anatomical course of the vessels.