Single coronary artery with prepulmonic coursing left main coronary artery: Manifesting as prinzmetal's angina

Garrett B. Sanford, Behzad Molavi, Anjan K. Sinha, Luis Garza, Paolo Angelini

Research output: Contribution to journalArticle

7 Scopus citations


We report the case of a 32-year-old man who presented at the emergency department with severe chest pressure, left arm pain, and dizziness. These symptoms were described as intermittent, occurring after exercise and at rest. He had undergone several stress tests during the past 8 years, but no objective evidence of ischemia was produced. His history of hyperlipidemia and increasing frequency of symptoms prompted us to perform coronary angiography, which showed a single coronary artery with an ostium at the right sinus of Valsalva. The vessel had an initial, mixed common trunk that gave rise to both the right coronary artery proper and to the left coronary artery. The left main trunk followed a prepulmonic course. The anatomic features were eventually confirmed by computed tomographic angiography. The left main stem had a fixed 50% to 60% area narrowing, at baseline study. A treadmill stress myocardial perfusion study showed no evidence of ischemia. The patient was referred to a 2nd facility, where intravascular ultrasonography, at base-line, revealed 63% left main narrowing without evidence of atherosclerosis. Acetylcholine provocation demonstrated worsening of the stenosis to about 80%, with reproduction of angina and ST-segment depression, which indicated that medical management of spasm might provide symptomatic relief.

Original languageEnglish (US)
Pages (from-to)449-452
Number of pages4
JournalTexas Heart Institute Journal
Issue number4
StatePublished - Dec 1 2007
Externally publishedYes


  • Coronary IVUS
  • Coronary angiography
  • Coronary vessel anomalies/ classification/complications/diagnosis
  • Prinzmetal's angina
  • Single coronary artery
  • Sinus of valsalva/abnormalities
  • Ultrasonography, interventional

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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