Isolated Coronary Artery
A 64-year-old woman with hypertension presented to the emergency department with a 3-day history of chest pain at rest and with exertion. An electrocardiogram showed sinus rhythm and T-wave inversions in the inferior leads. The troponin I level was 3.068 ng per milliliter (reference range, 0 to 0.016). An echocardiogram showed a left ventricular ejection fraction of 58%, hypokinesis of the inferior wall, and mild mitral regurgitation. Coronary angiography was performed; however, the ostium of the left coronary artery could not be identified. Cannulation of the right coronary ostium in the right sinus of Valsalva showed an isolated coronary artery (video) with severe stenosis in the middle portion and intracoronary thrombus (arrow). This artery followed the course of a normal right coronary artery but then proceeded through a posterolateral branch into the atrioventricular sulcus and divided into branches that supplied the lateral and anterior walls. The stenosis was treated with stenting. The presence of a single coronary system is uncommon and may be found incidentally on coronary angiography. At a follow-up visit 3 months after discharge, the patient was asymptomatic while receiving medical treatment, including dual antiplatelet therapy.
Source: https://youtu.be/jdXBWzVnaLs?si=Gj_xsXSivFs1H881