Isolated single coronary artery originating from a single right coronary ostium in a patient with acute myocardial infarction

Single coronary artery in which all three coronary arteries originate from the right sinus of Valsalva through a single ostium is a rare anomaly and its association with acute myocardial infarction (AMI) is even rarer. A 63-year-old female patient was admitted with severe chest pain of sudden onset, radiating to the neck and the left arm. Electrocardiographic findings were consistent with inferior lateral AMI. Coronary angiography demonstrated that the left anterior descending (LAD), the left circumflex (LCx) and the right coronary (RCA) arteries originated from the right sinus of Valsalva through a single ostium. There was severe discrete stenosis (95%) in the mid-portion of the RCA, and severe segmental stenosis (90%) in the proximal portion of the LCx, without any occlusion in the LAD. The patient refused recommendations for elective percutaneous coronary intervention or coronary bypass surgery and was discharged one week after angiography.