Mohanty Abhisekh, Chandra Sharad
Senior Resident, Department of Cardiology, King George Medical University, Lucknow, India.
Professor, Department of Cardiology, King George Medical University, Lucknow, India.
Indian Heart J. 2015 Jul-Aug;67(4):389-91. doi: 10.1016/j.ihj.2015.03.015. Epub 2015 Apr 27.
A 45 year male patient with no risk factors and no associated cardiac anomaly presented to us with exertional chest pain since 10 years. During coronary angiography, we were unable to intubate the left main coronary artery. Cannulation of the right coronary ostium showed a 'superdominant' Right coronary artery, which initially followed the course of the normal right coronary artery, then proceeded via a posterolateral segment into the course of the normal left circumflex artery, and finally followed the course of the normal left anterior descending artery (Images 1-3).CT coronary angiogram confirmed the findings (Images4-5). Intramyocardial bridging was also seen which explained the angina. This subtype is named type R-IA according to Lipton's classification and is by far the most rare type of single coronary artery with an incidence of 0.0008%. Some patients may present with myocardial ischemia or stable angina. The exact mechanism is unknown but may be related to intramyocardial bridging or coursing of epicardial arteries between great arteries.
一名45岁男性患者，无危险因素且无相关心脏异常，自10年前起出现劳力性胸痛。在冠状动脉造影过程中，我们无法插入左冠状动脉主干。右冠状动脉开口插管显示为“优势型”右冠状动脉，其起初走行于正常右冠状动脉路径，接着经后外侧段进入正常左旋支动脉路径，最后走行于正常左前降支动脉路径（图1 - 3）。CT冠状动脉造影证实了这些发现（图4 - 5）。还发现了心肌桥，这解释了心绞痛的原因。根据利普顿分类，这种亚型被命名为R - IA型，是迄今为止最罕见的单支冠状动脉类型，发病率为0.0008%。一些患者可能表现为心肌缺血或稳定型心绞痛。确切机制尚不清楚，但可能与心肌桥或心外膜动脉在大动脉之间的走行有关。
