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\begin{document}

\title{Isolated single coronary artery from noncoronary sinus.}



\author[1]{Meenu Bagarhatta}%
\author[1]{Ritu Agarwal}%
\author[1]{Rengarajan Rajagopal}%
\affil[1]{SMS Medical College and Hospital}%


\vspace{-1em}



  
  \date{June 02, 2024}


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\begin{abstract}
We present the CT angiogram images of a 43 year old lady with an
isolated single coronary artery arising from the noncoronary sinus with
a narrow slit like orifice and oblique take off.%
\end{abstract}%



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\textbf{Legend:}

A ``single'' coronary artery arises from the aorta by a single ostium
and supplies entire heart. They are extremely rare abnormalities
(prevalence of less than 0.06\% in angiographic studies) seen usually in
association with other congenital cardiac anomalies like coronary
fistulae and bicuspid aortic valve. CT coronary angiogram of a 43 year
lady with atypical chest pain (VRT and axial scans - Image.1) shows a
single coronary artery arising from the noncoronary sinus with a narrow
slit-like and oblique take off, coursing in the anterior
interventricular groove to divide into left anterior descending
artery(LAD) and left circumflex artery(LCx). The conal artery(CA)
originates from mid LAD and has a pre-pulmonic course to reform a
hypoplastic proximal right coronary artery(RCA) seen in the right
atrio-ventricular groove. The LCx is seen to give rise to a large
posterior descending artery supplying the inferior surfaces of both
ventricles. The left and right coronary sinuses (LCS \& RCS) are blind
ending. This pattern can be classified as ``IIa'' course according to
the Lipton classification {[}1{]}. No other intracardiac defects were
seen. Patients may be asymptomatic, have non-specific symptoms, chest
pain, congestive heart failure and in extreme cases, sudden cardiac
death. Coronary CT angiography can precisely delineate the course of the
anomalous artery and its relation to other cardiovascular structures to
help planning for surgery in symptomatic patients. There is no clear
consensus on management of asymptomatic patients, however, symptomatic
patients and patients having a malignant course may require corrective
surgical procedures for symptom relief. Our patient also had a single
coronary artery with a slit like orifice and oblique take off in the
absence of other congenital cardiac anomalies, which to our knowledge
has not been previously reported in literature. She is under close
clinical observation with a plan for bypass surgery in the event of any
complications.

References:

Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. Isolated single
coronary artery: diagnosis, angiographic classification, and clinical
significance. Radiology (1979), 130(1), 39--47.

Conflicts of interest: The authors declare no conflicts of interest

Informed consent: Obtained

Funding source: None

Word count: 304 words

Acknowledgements: Nil



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