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Cardiovascular Medicine
Volume 14
Issue 6
10.4414/cvm.2011.01596
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Interesting Images

Myocardial Infarction in a Patient with a Single Coronary Artery

by
Marcus Mutschelknauss
1,
Peter T. Buser
1,
Christoph Kaiser
1,
Jean-Luc Crevoisier
2 and
Michael J. Zellweger
2,*
1
Cardiology Department, University Hospital, 4031 Basel, Switzerland
2
Hôpital du Jura, 2800 Delémont, Switzerland
*
Author to whom correspondence should be addressed.
Cardiovasc. Med. 2011, 14(6), 195; https://doi.org/10.4414/cvm.2011.01596
Submission received: 29 March 2011 / Revised: 29 April 2011 / Accepted: 29 May 2011 / Published: 29 June 2011
Browse Figure
Versions Notes

A 56-year-old male patient was admitted because of ST-elevation myocardial infarction (STEMI) with STelevations in lead I and aVL. The emergent coronary angiography did not show any vessel originating from the left coronary sinus (panel A) but a single coronary artery originating from the right coronary sinus (panel B). The proximal left coronary artery (LCA) was occluded.
Cardiovascmed 14 00195 g001
Figure. Panel A: Absent artery in the left coronary sinus. Panel B: Injection into the right coronary sinus showing a single coronary artery with occlusion of proximal LCA (*). Panel C: PCI/stenting of occluded proximal LCA. Panel D: Post PCI result with TIMI 3 flow.
Figure. Panel A: Absent artery in the left coronary sinus. Panel B: Injection into the right coronary sinus showing a single coronary artery with occlusion of proximal LCA (*). Panel C: PCI/stenting of occluded proximal LCA. Panel D: Post PCI result with TIMI 3 flow.
Cardiovascmed 14 00195 g001
During the procedure, several episodes of ventricular tachycardia/ventricular fibrillation occurred and the patient developed severe haemodynamic impairment and pulmonary oedema. Therefore, a percutaneous left ventricular assist device (Impella Recover®) was implanted. Percutaneous coronary intervention (PCI) and stenting of the LCA (Panel C and D) with a bare metal stent (Prokinetic®) was performed. After PCI and three days of assist device support, the patient was stable and left ventricular ejection fraction improved after discharge from 30% to 44%.
Anomalous origin of the left coronary artery from the right coronary sinus as a single coronary artery is a rare coronary anomaly, particularly in the absence of other congenital heart diseases. It is reported in about 0.15% of coronary angiographies [1,2]. Coronary segments with an abnormal course are as vulnerable to atherosclerosis as normal segments. First clinical symptoms of coronary artery abnormalities may be anginal chest pain, acute myocardial infarction, syncope or sudden death. However, due to the unusual course of the coronary artery, PCI might be technically challenging.
Echo loops (AVI video files) of the bedside echo showing severely impaired left ventricular function can be viewed on the website of “Cardiovascular Medicine” www.cardiovascmed.ch

Funding/potential competing interests

No financial support and no other potential conflict of interest relevant to this article were reported.

References

  1. Angelini, P.; Velasco, J.A.; Flamm, S. Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation 2002, 105, 2449–2454. [Google Scholar] [CrossRef] [PubMed]
  2. Yamanaka, O.; Hobbs, R.E. Coronary artery anomalies in 126 595 patients undergoing coronary arteriography. Catheterization and cardiovascular diagnosis 1990, 21, 28–40. [Google Scholar] [CrossRef] [PubMed]

Share and Cite

MDPI and ACS Style

Mutschelknauss, M.; Buser, P.T.; Kaiser, C.; Crevoisier, J.-L.; Zellweger, M.J. Myocardial Infarction in a Patient with a Single Coronary Artery. Cardiovasc. Med. 2011, 14, 195. https://doi.org/10.4414/cvm.2011.01596

AMA Style

Mutschelknauss M, Buser PT, Kaiser C, Crevoisier J-L, Zellweger MJ. Myocardial Infarction in a Patient with a Single Coronary Artery. Cardiovascular Medicine. 2011; 14(6):195. https://doi.org/10.4414/cvm.2011.01596

Chicago/Turabian Style

Mutschelknauss, Marcus, Peter T. Buser, Christoph Kaiser, Jean-Luc Crevoisier, and Michael J. Zellweger. 2011. "Myocardial Infarction in a Patient with a Single Coronary Artery" Cardiovascular Medicine 14, no. 6: 195. https://doi.org/10.4414/cvm.2011.01596

APA Style

Mutschelknauss, M., Buser, P. T., Kaiser, C., Crevoisier, J.-L., & Zellweger, M. J. (2011). Myocardial Infarction in a Patient with a Single Coronary Artery. Cardiovascular Medicine, 14(6), 195. https://doi.org/10.4414/cvm.2011.01596

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