Case report of mitral valve replacement in a single coronary artery patient: devil is hidden in the details

Single coronary artery (SCA) is a rare congenital anomaly that may have serious clinical consequences in different clinical settings despite often being asymptomatic.

We report a case of a 75-year-old patient with a SCA originating from the right sinus of Valsalva presenting for pre-operative assessment for mitral valve (MV) stenosis. The patient developed cardiogenic shock post MV replacement surgery on grounds of iatrogenic occlusion of the ectopic left main coronary artery which was treated with a percutaneous revascularization procedure.

SCA represents a major anatomical variant that can significantly impact clinical outcomes, particularly during cardiac surgery. An abnormal coronary anatomy poses technical challenges, due to potential inadvertent injury or compression of the anomalous artery relative to the extent of the myocardium at risk.