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Single coronary artery: evaluation of conventional two-dimensional and gadolinium-enhanced three-dimensional MR coronary angiography.

The patient was a 33-year-old man who was evaluated for a 1-year history of chest pain on exertion. He had had several syncopal episodes in the prior year with episodes of diaphoresis and nausea with exercise. He had a strong family history of coronary artery disease. The patient’s physical examination and laboratory values were unremarkable, as were his ECG and echocardiogram. Although a stress thalhum examination was interpreted as not showing coronary artery disease, the patient showed symptoms and complained of chest pain and dyspnea during the examination. Because of the patient’s confusing presentation, a cardiac catheterization was performed. Injection into the left coronary sinus showed a normal left main coronary artery origin but revealed an aberrant origin ofthe right coronary artery (RCA) from the proximal left anterior descending artery (LAD) (Fig. lA). The RCA coursed medially to return to the right atrioventricular groove. No separate right coronary ostium could be identified. Although the angiogram suggested that the RCA passed anterior to the pulmonary artery outflow tract after its origin in the LAD, its exact relationship to the aorta and pulmonary artery could not be evaluated. Given the patient’s symptoms and the unusual appearance of the coronary anatomy, a cardiac MR examination was performed. A 2D coronary MR angiogram was first per