Single coronary artery complicated with type A aortic dissection: a case report

TL;DR

A rare case of a single coronary artery combined with a severe aortic dissection is reported, highlighting the challenges in diagnosis and treatment.

Contribution

This case report adds to the limited literature on single coronary artery anomalies complicated by aortic dissection.

Findings

A 77-year-old woman had a single coronary artery arising from the left sinus of Valsalva with no right coronary artery orifice.

The patient experienced a type A aortic dissection, requiring urgent aortic arch replacement.

Only three similar cases have been previously reported in the literature.

Abstract

Congenital coronary artery anomalies complicated with aortic dissection are rare. We experienced a patient with a single coronary artery presenting with a type A dissecting aortic aneurysm. A 77-year-old woman who experienced sudden back pain and was diagnosed with type A acute aortic dissection was initially treated conservatively because the false lumen thrombosed entirely. Computed tomography taken during 5 weeks of hospitalization incidentally revealed an anomalous single coronary artery arising from the left sinus of Valsalva, and the right coronary artery orifice was absent. One month after being transferred to another institution for rehabilitation, she was reintroduced to us for re-dissection of the aorta. An urgent operation involving aortic arch replacement was performed. There was a solitary coronary artery orifice at the left sinus of Valsalva and no ostium at the right sinus. The postoperative course was uneventful, and the patient was discharged 14 days after the surgery. Only 3 cases involving a single coronary artery complicated with dissecting aortic aneurysm have been reported previously.

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