Ischaemic Ventricular Fibrillation in a Patient with Single Coronary Artery from the Right Sinus of Valsalva and Rudimentary Coronary Artery in the Left Sinus of Valsalva

C artery anomalies are seen in 0.6–5.6% of patients undergoing coronary angiography [1]. The overall incidence of single coronary artery is between 0.024 The coronary angiography was performed immediately. Angiography demonstrated a single coronary artery arising from the right sinus of valsalva, which gave off three and 0.044% [2]. The incidence of a left main coronary artery (LMCA) originating from the ostium of the right coronary artery (RCA) is very low and was detected in four cases out of a series of 50,000 coronary angiograms [3]. Life threatening symptoms, such as sudden death, arrhythmias, syncope and myocardial infarction, can occur in up to 20% of patients [2]. A 43 year-old man was referred to our hospital due to cardiac arrest after ischaemic ventricular fibrillation with successful defibrillation. Risk factors included smoking and family history. Physical examination revealed a blood pressure of 100/60 mmHg with a regular pulse of 50 beats per minute, heart murmurs were absent and there were no signs of heart failure. The electrocardiogram (ECG) showed ST-segment elevation in the leads II, III, aVF and V 4–6, and ST-segment depression in aVL (Fig. 1A). branches (Fig. 1B) and a rudimentary coronary artery originating from the left sinus of valsalva (Fig. 1C). A thrombotic total occlusion was observed in the distal part of posterior descending artery (Fig. 2). After administration of heparin, clopidogrel and acetyl salicylic acid, the patient was transferred to the intensive care unit with tirofiban infusion. The patient was discharged with isosorbide mononitrate, diltiazem, atorvastatin, clopidogrel and acetyl salicylic acid uneventfully. Coronary artery anomalies are asymptomatic and are usually detected as coincidental findings during coronary angiography or autopsy [2]. Findings can vary according to subtype of anomalous origin from asymptomatic patients to those who present with arrhythmia, myocardial ischaemia, angina pectoris, syncope, and sudden cardiac death.