Single coronary artery with prepulmonic left main coronary

Case contributed by Stefan Tigges
Diagnosis certain

Presentation

Chest pain.

Patient Data

Age: 50 years
Gender: Male

Single coronary artery arising from the right coronary cusp, dividing into a normal right coronary artery and a pre-pulmonic left main coronary artery. No external compression or intraluminal stenosis. This anatomy is a "benign" variant.

Normal & anomalous coronaries

Diagram

Normal, "malignant" and "benign" coronary artery origins.

Case Discussion

Anomalous coronary arteries may have a so-called benign (asymptomatic without risk of decreased blood flow) or a malignant (potentially symptomatic with risk of decreased blood flow, ischemia, and sudden death) course. In most cases, a vessel running between the aorta and the pulmonary artery has a malignant course. Vessels running in front of the pulmonary artery (pre-pulmonic) or behind the aorta (retroaortic) are considered to have a benign course.

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