Panichella Giorgia, Padeletti Margherita, Spaziani Gaia, Olivotto Iacopo, Favilli Silvia
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Hospital of Santa Maria Nuova, Florence, Italy.
JACC Case Rep. 2025 Sep 3;30(26):104875. doi: 10.1016/j.jaccas.2025.104875.
Single coronary artery is a rare congenital anomaly. Its coexistence with coronary artery fistula is exceedingly uncommon.
A 61-year-old woman with no cardiovascular risk factors underwent her first cardiological evaluation after incidental detection of atrial fibrillation. Imaging revealed a markedly dilated single coronary artery originating from the left coronary sinus, with a large fistula to the pulmonary artery trunk. Despite atrial enlargement and moderate mitral and tricuspid regurgitation, the patient was asymptomatic with preserved ventricular function. A conservative management strategy with close follow-up was adopted after multidisciplinary discussion.
Management of rare coronary anomalies should be individualized. While surgery is recommended in symptomatic patients or those with evidence of ischemia, asymptomatic individuals may be managed conservatively; however, signs of adverse cardiac remodeling should prompt early reconsideration of intervention.
TAKE-HOME MESSAGE: Conservative follow-up may be appropriate in asymptomatic patients with complex coronary anomalies, but progressive structural changes warrant timely reassessment of surgical options.
单支冠状动脉是一种罕见的先天性异常。其与冠状动脉瘘并存极为罕见。
一名61岁无心血管危险因素的女性在偶然发现房颤后首次接受心脏评估。影像学检查显示一条明显扩张的单支冠状动脉起源于左冠状窦，并有一个通向肺动脉干的大瘘管。尽管存在心房扩大以及中度二尖瓣和三尖瓣反流，但患者无症状，心室功能保留。经多学科讨论后采取了密切随访的保守治疗策略。
罕见冠状动脉异常的治疗应个体化。对于有症状的患者或有缺血证据的患者，建议进行手术治疗；而无症状的个体可采取保守治疗；然而，心脏不良重塑的迹象应促使尽早重新考虑干预措施。
对于患有复杂冠状动脉异常的无症状患者，保守随访可能是合适的，但结构的渐进性变化需要及时重新评估手术选择。
