Single coronary artery with prepulmonic coursing left main coronary artery

Manifesting as prinzmetal's angina

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

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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
Volume34
Issue number4
StatePublished - 2007
Externally publishedYes

Fingerprint

Variant Angina Pectoris
Coronary Vessels
Ischemia
Interventional Ultrasonography
Sinus of Valsalva
Spasm
Dizziness
Hyperlipidemias
Coronary Angiography
Exercise Test
Acetylcholine
Reproduction
Hospital Emergency Service
Atherosclerosis
Angiography
Pathologic Constriction
Arm
Thorax
Perfusion
Exercise

Keywords

  • Coronary angiography
  • Coronary IVUS
  • 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

Cite this

Single coronary artery with prepulmonic coursing left main coronary artery : Manifesting as prinzmetal's angina. / Sanford, Garrett B.; Molavi, Behzad; Sinha, Anjan; Garza, Luis; Angelini, Paolo.

In: Texas Heart Institute Journal, Vol. 34, No. 4, 2007, p. 449-452.

Research output: Contribution to journalArticle

Sanford, Garrett B. ; Molavi, Behzad ; Sinha, Anjan ; Garza, Luis ; Angelini, Paolo. / Single coronary artery with prepulmonic coursing left main coronary artery : Manifesting as prinzmetal's angina. In: Texas Heart Institute Journal. 2007 ; Vol. 34, No. 4. pp. 449-452.
@article{11c633ac28b8428ca08620470768b9d9,
title = "Single coronary artery with prepulmonic coursing left main coronary artery: Manifesting as prinzmetal's angina",
abstract = "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.",
keywords = "Coronary angiography, Coronary IVUS, Coronary vessel anomalies/ classification/complications/diagnosis, Prinzmetal's angina, Single coronary artery, Sinus of valsalva/abnormalities, Ultrasonography, interventional",
author = "Sanford, {Garrett B.} and Behzad Molavi and Anjan Sinha and Luis Garza and Paolo Angelini",
year = "2007",
language = "English (US)",
volume = "34",
pages = "449--452",
journal = "Texas Heart Institute Journal",
issn = "0730-2347",
publisher = "Texas Heart Institute",
number = "4",

}

TY - JOUR

T1 - Single coronary artery with prepulmonic coursing left main coronary artery

T2 - Manifesting as prinzmetal's angina

AU - Sanford, Garrett B.

AU - Molavi, Behzad

AU - Sinha, Anjan

AU - Garza, Luis

AU - Angelini, Paolo

PY - 2007

Y1 - 2007

N2 - 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.

AB - 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.

KW - Coronary angiography

KW - Coronary IVUS

KW - Coronary vessel anomalies/ classification/complications/diagnosis

KW - Prinzmetal's angina

KW - Single coronary artery

KW - Sinus of valsalva/abnormalities

KW - Ultrasonography, interventional

UR - http://www.scopus.com/inward/record.url?scp=37749013611&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37749013611&partnerID=8YFLogxK

M3 - Article

VL - 34

SP - 449

EP - 452

JO - Texas Heart Institute Journal

JF - Texas Heart Institute Journal

SN - 0730-2347

IS - 4

ER -