Single coronary artery - Lipton type L-I

Case contributed by Dr. Neil Eric Pecache

Presentation

Known hypertensive patient admitted for chest heaviness on exertion and palpitations. Physical examination unremarkable. ECG showed non-specific ST-T wave changes. Serial troponins were normal. Echocardiogram was unremarkable.

Patient Data

Age: 75 years
Gender: Female

The left main coronary artery (LMA) takes off from the left aortic sinus and bifurcates into a left anterior descending artery (LAD) and left circumflex artery (LCx).

The LMA is large and patent.  

The LAD wraps around the cardiac apex (type III vessel). 

The LCx extends to and traverses the base of the heart, then terminates at the right atrioventricular groove. A prominent marginal artery is seen.

The right coronary artery (RCA) is absent.

Mild coronary atherosclerosis with no significant stenoses.

Case Discussion

A single coronary artery is a rare congenital anomaly (less than 1% on CT angiography) where only one coronary artery arises from the aortic trunk. Lipton et al. divided it into two main types: right (R) and left (L), describing the single coronary artery as it originates from the right or left coronary sinus. Unlike other classification types where coronary perfusion may be compromised, the R1 or L1 classification usually has a benign clinical course.

Case submitted by Neil Eric L. Pecache, MD, Rainier John S. Buensalida, MD, and Simonette T. Sawit, MD.

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