Single Right Coronary Artery Supplying the Entire Heart
Notice bibliographique
Résumé
A 60-year-old man with hypertension, hyperlipidemia, and noninsulin-dependent diabetes had been followed for bicuspid aortic valve disease. Transthoracic echocardiography revealed severe bicuspid aortic valve stenosis with mean and peak transvalvular gradients of 57 mm Hg and 80 mm Hg, respectively. He recently became symptomatic and was put forth for surgical consideration. Preoperative angiography demonstrated that the left anterior descending (LAD) artery arose from the right coronary artery (RCA) (Fig. 1A). This vessel traversed to the anterior interventricular groove and provided normal LAD circulation. The left circumflex (LCX) artery was a continuation of the ongoing posterolateral artery and proceeded superiorly along the posterior interventricular groove providing the obtuse marginal vessels (Fig. 1B and C). Coronary computed tomography confirmed that the entire coronary circulation arose from the RCA with the LAD originating from the RCA (Fig. 1D). The single coronary artery branched into 2 vessels, one taking a course similar to an RCA and the other becoming the LAD. The RCA branch traveled posteriorly along the atrioventricular groove, bifurcating into the posterolateral artery and an ongoing left coronary system along the left atrioventricular groove in the expected location of the LCX providing the marginal branches (Fig. 1E and F). At surgery, antegrade cardioplegia was given via the aortic root once to achieve cardiac arrest. The stenotic bicuspid aortic valve was replaced with a biological valve. The RCA and adjacent LAD orifices were seen at a reasonable height above the aortic annulus, permitting standard supra-annular valve implantation. Because the LAD was not running in the aortic wall, there was no surgical revision to any coronary artery. However, the course of this artery would have surgical implications if aortic root procedures, such as a Bentall, an aortic valve-sparing root, or a Ross procedure, had been contemplated. These procedures require mobilization and reimplantation of the coronary ostia, which may have been challenging in this case. His subsequent postoperative course was uneventful. A single coronary artery is an extremely rare congenital coronary artery anomaly in which only 1 coronary artery arises from the aorta to supply the entire heart. The prevalence is 0.02% to 0.06% based on angiography.1Desmet W. Vanhaecke J. Vrolix M. et al.Isolated single coronary artery: a review of 50000 consecutive coronary angiographies.Eur Heart J. 1992; 13: 1637-1640Crossref PubMed Scopus (226) Google Scholar This variance may be associated with congenital heart diseases and an increased risk of sudden death due to decreased myocardial perfusion.2Topaz O. Demarchena E.J. Perin E. et al.Anomalous coronary arteries: angiographic findings in 80 patients.Int J Cardiol. 1992; 34: 129-138Abstract Full Text PDF PubMed Scopus (209) Google Scholar The relationship between bicuspid aortic valves and single coronary artery is unclear; however, a case report has been published.3Zoltowska D.M. Agrawal Y. Thind G.S. Kalavakunta J.K. Single coronary artery with bicuspid aortic valve.BMJ Case Rep. 2018; 2018 (bcr2018225309)Google Scholar We have reported a rare case of bicuspid aortic valve stenosis associated with a coronary anomaly. Although routine aortic valve replacement was performed uneventfully in this case, the need for a more complicated root procedure (due to aneurysm, dissection, infection, or desire for a pulmonary autograft) would have been complicated by this anomaly. Because the entire coronary circulation is dependent on a single coronary orifice, any complications related to coronary reimplantation would have been poorly tolerated. This case illustrates the need for preoperative coronary angiography in patients undergoing aortic valve surgery, particularly if a root procedure is being contemplated. The authors have no funding sources to declare.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».