Prifti Edvin, Ademaj Fadil, Krakulli Klodian, Rruci Edlira, Zeka Merita, Demiraj Aurel
Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania.
Division of Cardiology, Gjakovo Hospital, Rr. Prizren, Gjakovo, Kosovo.
J Med Case Rep. 2016 Jul 1;10(1):190. doi: 10.1186/s13256-016-0977-5.
Coronary arteries originating from the right coronary ostium in the ascending aorta represent a very rare anatomic presentation. Also, the presence of a single coronary ostium is an extremely rare finding.
We present the case of a 74-year-old Albanian man from Kosovo. He had unstable angina due to critical triple vessel disease and a single coronary artery originating from a single ostium in the right sinus of Valsalva with an anomalous course of his left anterior descending artery anteriorly to the right ventricular outflow tract as a "T-vessel" from which originated the proximal and distal left anterior descending artery, the circumflex artery originating from the mid portion of the right coronary artery which had a normal course. He underwent successful coronary revascularization consisting of three vein grafts to the right coronary artery, first diagonal and obtuse marginal artery, and left internal mammary artery anastomosed to left anterior descending artery.
We describe a proposed IID1 pattern. After a careful revision of the literature, only six cases have been reported with a similar anomalous coronary origin. Only two out of six patients underwent surgical coronary revascularization. In our case the aberrant vessel arising from his right coronary artery coursed anteriorly to the right ventricle and continued as a left anterior descending artery at its mid portion which then continued distally as the distal left anterior descending artery and proximally as a proximal left anterior descending artery, having the shape of a "T vessel". The "T-vessel" configuration has never been reported in the literature. The reported case with its specific presentation adds further information on this rare form of anomalous origin of the coronary arteries, representing a first report of a configuration that we name the "T-vessel" of the left anterior descending artery. Diagnosis of the coronary anatomy is very important for the invasive cardiologist and cardiac surgeon in cases with a single coronary ostium, such as our case, so that they can proceed with the invasive or surgical treatment when critical coronary artery disease is present.
起源于升主动脉右冠状动脉开口的冠状动脉是一种非常罕见的解剖表现。此外，单冠状动脉开口的情况极其罕见。
我们报告了一名来自科索沃的74岁阿尔巴尼亚男子的病例。他因严重的三支血管病变和不稳定型心绞痛入院，其单支冠状动脉起源于瓦尔萨尔瓦窦右侧的单一开口，左前降支动脉走行异常，在右心室流出道前方呈“T形血管”，近端和远端左前降支动脉由此发出，回旋支动脉起源于走行正常的右冠状动脉中部。他接受了成功的冠状动脉血运重建，包括三根静脉桥血管分别与右冠状动脉、第一对角支和钝缘支动脉吻合，以及左乳内动脉与左前降支动脉吻合。
我们描述了一种拟议的IID1模式。在仔细查阅文献后，仅报道了6例类似的冠状动脉异常起源病例。6例患者中只有2例接受了外科冠状动脉血运重建。在我们的病例中，异常血管从右冠状动脉发出，在右心室前方走行，在其中部延续为左前降支动脉，然后向远端延续为远端左前降支动脉，向近端延续为近端左前降支动脉，呈 “T形血管” 形状。文献中从未报道过 “T形血管” 构型。所报告的病例及其特殊表现为这种罕见的冠状动脉异常起源形式提供了更多信息，代表了我们命名为左前降支动脉“T形血管”构型的首次报告。对于单冠状动脉开口的病例，如我们的病例，冠状动脉解剖结构的诊断对于介入心脏病学家和心脏外科医生非常重要，以便在存在严重冠状动脉疾病时能够进行介入或手术治疗。
