International Journal of Cardiology 88 (2003) 309–311 www.elsevier.com / locate / ijcard Letter to the Editor Right coronary artery originating from distal left circumflex: an extremely rare variety of single coronary artery a, a b a a * Hasan Turhan , Erdal Duru , Ertan Yetkin , Ramazan Atak , Kubilay Senen a Department of Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey b Department of Cardiology, Medical Faculty, Inonu University, Malatya, Turkey Received 10 April 2002; accepted 6 May 2002 Abstract Single coronary artery is a rare congenital anomaly of the coronary circulation which is often associated with other congenital cardiac malformations. Right coronary artery arising from the distal left circumflex artery is an extremely rare variety of single coronary artery. We report a patient with a single coronary artery system, in whom the right coronary artery originated from the distal left circumflex. No other associated cardiac anomaly was detected.  2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Congenital coronary anomaly; Single coronary artery 1. Introduction evaluation of chest pain. He explained his complaint as retrosternal sharp or pressure-like chest pain which Single coronary artery (SCA) is a rare congenital was sometimes precipitated by effort but often anomaly of the coronary circulation, which is often occurred at rest. The pain usually lasted about 30 associated with other congenital cardiac malforma- min. Past medical history revealed hypertension and tions [1,2]. Anomalous origin of one or more cor- cigarette smoking as atherosclerotic risk factors. On onary arteries occurs in about 0.6% of patients physical examination, no abnormal findings were undergoing coronary angiography [3]. In the present detected. Electrocardiogram and telecardiogram were case, we report a patient with SCA as an isolated normal. Transthoracic echocardiographic findings anomaly, in whom the right coronary artery origi- were within normal limits. Treadmill exercise test nated from the distal left circumflex coronary artery. showed 1-mm ST segment depression in leads V4– V6. Cardiac catheterization was performed. Initially, the right coronary artery could not be cannulated in 2. Case report its usual location. The left coronary artery and its branches were normal in origin and distribution. A 52-year-old man was admitted to our hospital for However, the right coronary artery arose from the distal left circumflex coronary artery and followed the course, retrogradely, of the normal right coronary *Corresponding author. Turkocagi Caddesi 20, Sokak No. 2 / 2 Balgat, artery distribution (Figs. 1 and 2). The distal portion 06520 Ankara, Turkey. Tel.: 190-312-2867-658. E-mail address: drhturhan@yahoo.com (H. Turhan). of right coronary artery was tapered and terminated 0167-5273 / 02 / $ – see front matter  2002 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S0167-5273(02)00324-8