most coronary artery origin abnormalities are incidentally determined during coronary angiography . in the adult population ,
its prevalence is reported to be approximately 0.3 to 1.3% in the largest registry.1 ) these abnormalities are usually asymptomatic and have no clinical significance
. however , some cases of coronary artery abnormalities are related to severe life - threatening events such as myocardial ischemia , arrhythmia and acute myocardial infarction.2 ) we report an uncommon case of an anomalous origin of the left coronary artery ( lca ) , a single coronary artery , arising from the right sinus , with angina pectoris and palpitations .
a 48-year - old woman presented with exertional angina and palpitations for a long time .
she a had medical history of hypertension and dyslipidemia , and a family history of coronary artery disease .
the exercise electrocardiogram showed dynamic changes with st - segment depression in the v 1 - 4 leads .
the coronary angiography procedure was started with a lca cannulation attempt , but left anterior descending coronary artery and cx imaging was unsuccessful even though contrast was injected into the left coronary sinus .
the right coronary artery was cannulated and visualized with a right judkins catheter . at this time
the right judkins catheter was gently pull back and the left coronary arteries were clearly visualized ( figs . 1 and 2 ) .
coronary ct angiography confirmed that the left coronary arteries arose from the right sinus of valsalva and that all three coronary arteries originated from the single sinus ( fig .
the patient was managed with conservative treatment and has had no symptoms on clinical follow - up .
coronary anomalies affect less than 1% of the general population . anomalous origin of lca from the right sinus of valsalva is the rarest anomaly , with a reported prevalence of 0.02 - 0.03% according to studies .
the isolated origin of a single coronary artery is very rare , with an incidence of 0.04% to 0.23%.3 ) most of these coronary artery anomalies are generally asymptomatic ; however , some can cause severe potentially life threatening events .
understanding anatomic coronary variations is important in determining anomalous origins that are related to sudden cardiac death.4 ) single coronary artery has been defined angiographically by lipton et al.5 ) according to the origin from the coronary artery .
the modified lipton classification includes features such as the anatomical distribution , the ostial location , and the course of the transverse trunk .
anomalous origin of the lca from the right sinus of valsalva is associated with sudden death in some cases ( 59% ) because an anomalous artery between two great vessels is related with acute myocardial infarction and sudden cardiac death.6 ) the acute angle of the ostium increases the risk of sudden cardiac death .
the anomaly determined in our patient seemed to be potentially malignant , but without marked compression between the great arteries .
the management of patients with an anomalous origin of coronary artery includes observation , medical treatment , coronary stent implantation and surgery repairment .
however , in our case medical treatment was chosen due to the absence of compression of the coronary arteries by the great arteries , and the lack of acute ostial angulation .
the patient was treated with a beta blocker and nitroglycerin because of the angina pectoris and palpitations , and she has remained asymptomatic for 1 year on follow - up .
although cardiac catheterization is generally accepted as the gold standard for the evaluation of coronary anomalies , ct angiography has recently emerged as an effective and noninvasive method for performing imaging of the origin of the coronary arteries . in conclusion ,
the determination of the anomalous origin of the coronary artery and the cardiovascular system is of great clinical importance due to its severe life - threatening complications .
the new imaging modalities that have emerged enable the accurate visualization of the anatomical configurations and the detection of structural malformations .
most of the structural cardiovascular abnormalities are incidentally detected and are asymptomatic ; however , a few are potentially significant and can trigger sudden death .
 anomalous origin of coronary arteries is generally asymptomatic and a rare disease . 
 however , some cases can cause severe life - threatening events such as myocardial ischemia , arrhythmia , and acute myocardial infarction . 
 we describe a case of a single coronary artery arising from the right sinus of valsalva in a 48-year - old female patient with a complaint of stable angina pectoris and palpitations . 
 coronary angiography revealed that all three coronary arteries arose from the right sinus . 
 coronary ct angiography confirmed that there was an anomalous origin of the left coronary artery arising from the right sinus of valsalva . 
 the patient was managed with conservative treatment . 
Introduction
Case
Discussion