Single coronary artery arising from right aortic sinus in a symptomatic patient

Coronary origin and course anomalies affect ∼1% of the general population.Single coronary artery is a rare congenital anomaly of the coronary arteries that occurs in approximately 0.02–0.07% of the population.In this report, we present a case of a single coronary artery arising from the right aortic sinus, the presence of which was suspected following conventional coronary angiography and then confirmed by 64-slice multidetector-computed tomography coronary angiography.The onset of an attack of angina enabled us to observe, by means of myocardial perfusion imaging, a captation defect in the distribution region of the left anterior descending coronary artery.Selective cannulation of this vessel failed during subsequent coronary angiography. However, multidetector-computed tomography coronary angiography showed that it originated from a single coronary artery arising from the right aortic sinus, was small, and presented a calcific proximal plaque with mild stenosis.These elements, together with the effect of the patient's sustained physical exertion, can account for stress-related ischemia in a poorly vascularized myocardial region.Re-assessment of the case by multidetector-computed tomography coronary angiography approximately 2 years later, following a new event of angina, revealed that the disease had progressed.A new and significant lipidic plaque had appeared in the left anterior descending coronary artery tract immediately below the aforementioned calcific stenosis.