Single coronary artery with bicuspid aortic valve

Description

A 45-year-old man with known history of coronary artery disease and bicuspid aortic valve (BAV) (figure 1) was admitted for worsening symptoms of angina. Coronary angiogram showed single coronary artery arising from the left cusp, trifurcating into right coronary artery, left anterior descending (LAD) and left circumflex artery (LCx) (figure 2). No course of the left main coronary artery between the aortic root and the pulmonary artery was noted. There was obstructive disease in proximal LAD (70%), first diagonal artery (80%) and proximal LCx (70%). Peak gradient of 51 mm Hg across the BAV was registered. He underwent bypass graft surgery along with an aortic valve replacement successfully.

Figure 1

Transoesophageal echocardiogram. Parasternal short axis view revealing bicuspid aortic valve (BAV). Red arrows pointing at aortic valve cusps.

Figure 2

(A) Left anterior oblique (LAO) caudal view....

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