Ludhwani Dipesh, Woo Vincent
Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 W. Medical Center Drive, McHenry, IL 60050, USA.
Eur Heart J Case Rep. 2019 Oct 4;3(4):1-6. doi: 10.1093/ehjcr/ytz169. eCollection 2019 Dec.
Anomalous origin of the coronary arteries is seen in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. We present an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and following a prepulmonic course.
A 72-year-old woman presented due to ongoing chest pain with associated ST-segment elevation involving the inferior leads. Emergent cardiac catheterization revealed a 99% ulcerated lesion in distal RCA, which was intervened on with angioplasty and stent placement. The RCA was noted giving rise to LMCA, which followed a prepulmonic course (anterior to pulmonary artery) before trifurcating into a small caliber left anterior descending, ramus intermedius, and hypoplastic left circumflex arteries. The non-malignant course of the aberrant LMCA was confirmed on the coronary computed tomography angiogram. The patient was discharged home on guideline-directed medical therapy.
The patient illustrated congenital SCA with type RIIA pattern of the aberrant vessel based on the Lipton anatomic classification for SCA. The prepulmonic course of SCA is usually benign and can be managed conservatively.
冠状动脉异常起源在普通人群中的发生率不到1%。单冠状动脉（SCA）是一种先天性解剖异常，其特征为单一冠状动脉开口发出一条冠状动脉。我们报告了一种极为罕见的变异情况，即左主干冠状动脉（LMCA）从右冠状动脉（RCA）分支并走行于肺动脉前。
一名72岁女性因持续性胸痛伴下壁导联ST段抬高就诊。急诊心脏导管检查显示右冠状动脉远端有一处99%的溃疡性病变，对其进行了血管成形术和支架置入治疗。注意到右冠状动脉发出左主干冠状动脉，该左主干冠状动脉走行于肺动脉前（肺动脉前方），然后分为小口径的左前降支、中间支和发育不良的左旋支动脉。冠状动脉计算机断层扫描血管造影证实了异常左主干冠状动脉的非恶性走行。患者接受指南指导的药物治疗后出院。
根据Lipton对单冠状动脉的解剖分类，该患者表现为先天性单冠状动脉伴异常血管的RIIA型模式。单冠状动脉走行于肺动脉前通常为良性，可保守治疗。
