Letter to the Editor Myocardial infarcts in a patient with a single right sided coronary ostium and interarterial course of the circumflex artery: The role of multi-modality imaging J.P. Smedema a,b,c, ⁎ , A.E. Berlion d , H. Morkel e a Lazaron Heart Clinic, Suite 103, Medical Chambers, N1 City Hospital, Goodwood 7460, South Africa b Department of Medicine, University of Capetown, South Africa c UCT Private Academic Hospital, Observatory 7925, South Africa d Drs Schnetler, Corbett and Partners Inc, Panorama Medi-Clinic, Panorama 7500, South Africa e Suite 20, Panorama Medical Centre, Panorama 7500, South Africa Received 23 June 2007; accepted 7 July 2007 Available online 19 November 2007 Abstract A solitary coronary ostium, in the absence of other congenital cardiovascular abnormalities, is a rare finding at angiography, and may be associated with myocardial ischemia and sudden cardiac death. We present a 46-year-old female who presented with a non-ST-segment- elevation myocardial infarct in whom the diagnosis of a single coronary artery with right sided ostium was made during diagnostic coronary angiography. Multi-detector computed tomography and gadolinium-enhanced cardiovascular magnetic resonance were valuable in delineating the extremely rare IIE1 coronary anatomy, the localization and the extent of myocardial necrosis. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Coronary artery; Congenital anomaly; Coronary angiography; Magnetic resonance imaging; Multi-detector computed tomography; Single photon emission computed tomography 1. Case-report A 46-year-old female was referred with new onset angina pectoris CCS class 4/4 and vegetative symptoms, which had not been brought on by exertion, and had been intermittently present for approximately 48 h. The cardio- vascular risk factors consisted of central obesity, primary arterial hypertension, low HDL (0.98 mmol/L), sedentary life style and a positive family history of premature atherosclerosis. Physical examination was normal. The resting 12-lead electrocardiogram showed 1-2 mm hori- zontal or downslope ST-segments depressions in leads II, III and aVF. The troponine T was 0.26 ng/L at admission. Echocardiography demonstrated mild hypokinesia of the inferior segments. Coronary angiography revealed a single right sided coronary (RCA) ostium and a suspected interarterial course of the left circumflex coronary artery (LCx) (Figs. 1A, D and 2A). Contrast-enhanced Multi- Detector Computed Tomography (MDCT) confirmed the interarterial course of the LCx and revealed the left anterior descending coronary artery (LAD) running anterior to the right ventricular outflow tract (Figs. 1B, C, E and 2B). Delayed contrast-enhanced cardiovascular magnetic reso- nance demonstrated a small subepicardial infarct in the distribution of the LCx, as well as a transmural apical infarction in the distribution of the posterior descending branch of the right coronary artery (Figs. 1F and 2D, E). Since our patient was unable to sufficiently exercise due to International Journal of Cardiology 132 (2009) e42 – e44 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Medical Chambers, Room 103, N1 City Hospital, S. Douglas street, Goodwood 7460, South Africa Tel.: +27 21 5953813; fax: +27 21 5953814. E-mail address: jansmedema@hotmail.com (J.P. Smedema). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.07.114