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ABSTRACT
In this case report, a patient with rheumatic mitral stenosis and R-1 suPtype single : coronary artery arising from the ascending aorta ("high take-off" origin) and coursing between the aorta and pulmonary artery is presented. The clinical significance and differential diagnosis are discussed. To the authors' knowledge, this is the first case reported in the literature with a single R-1 subtype coronary artery that shows "high take-off origin.
Introduction Single coronary artery is a rare congenital anomaly of the coronary arteries in which only one coronary artery arises from the aortic trunk with a single coronary ostium. This is an extremely rare congenital anomaly and is seen in only 0.0024% to 0.044% of the population.1 Single coronary artery is found more often among patients with truncus arteriosus, tetralogy of Fallot, and pulmonary atresia.2-4 Although the presence of a single coronary artery is usually considered as a benign condition, it has some prognostic implications depending on its origin, distribution, and relation with early atherosclerosis.5 This article reports on a patient with rheumatic mitral stenosis who has a single R-1 subtype coronary artery that originates from the ascending aorta, 2-3 cm above the left sinus of Valsalva, and who has no evidence of myocardial ischemia despite the interarterial course. Case Report The patient is a 47-year-old woman with a 4-year history of palpitation and exertional dyspnea. She was diagnosed as having moderate rheumatic mitral stenosis 3 years ago. Previously she was admitted to our hospital with a history of an increase in the frequency and severity of symptoms that did not respond to drugs she used. In the present physical examination, heart rate was 98/min with a regular rhythm, and the blood pressure was 100/60 mmHg. Auscultation of the patient revealed increased intensity of the first heart sound, a diastolic rumbling murmur following a mitral opening snap in the apex, a lowintensity regurgitant diastolic murmur in the mesocardiac region, and increased intensity of the second heart sound in the pulmonic area. The routine laboratory findings were normal. The electrocardiography of the patient showed sinus rhythm and left atrial enlargement. The pulmonary conus and the left atrial margins were prominent in the chest x-ray film. The two-dimentional and color Doppler echocardiographic examination revealed fibrotic...