A Rare Coronary Anomaly: Single Coronary Artery; Two Cases

We present two cases of a rare coronary anomaly—single coronary artery—identified incidentally during routine coronary angiography. Both patients presented with symptoms of chest pain and exertional angina. In both cases, the anomaly is located in the right sinus of Valsalva (R-1-A) and crosses the heart anterior to the right ventricle. (Figure 3) The first patient experienced significant stenosis in the proximal left anterior descending artery, which was successfully treated with percutaneous stent implantation. The second patient's chest pain was managed effectively with medical therapy alone. These cases highlight that a single coronary artery, often asymptomatic, can exist as a congenital anomaly in patients experiencing myocardial ischemia due to atherosclerotic coronary artery disease. Furthermore, they demonstrate that percutaneous coronary intervention, including stent placement, offers a promising treatment approach. In the literature, coronary artery bypass surgery should particularly be considered as a treatment option for these coronary anomalies. However, it has also been shown that in selected cases, percutaneous intervention or medical therapy can be viable alternatives.