Myocardial Infarction Due to an Anomalous Origin of the Left Coronary Artery with Unique Aggravating Features

Abstract

Anomalous left coronary artery arising at the right sinus of Valsalva is a relatively rare congenital cardiac anomaly that can cause myocardial ischemia.1 It can follow one out of five aberrant courses: interarterial, subpulmonic, pre-pulmonic, retroaortic, or retrocardiac.2 \n \nWe present the case of a young patient with an anomalous left coronary artery arising at the right sinus of Valsalva with severe stenosis and hypoplasia throughout the interarterial segment, which hampered corrective surgery. The timely detection and adequate treatment of this specific anomaly gains relevance because of its association with increased risk of sudden cardiac death. Although the true prevalence of interarterial anomalous left coronary artery is unknown, owing to the lack of population-wide screening studies and at times asymptomatic course, its frequency has been reported at 0.03%.3 Imaging techniques allow the characterization of the coronary anomalous origin, course, morphology and surrounding structures. Transthoracic echocardiography, magnetic resonance angiography, and computed tomography (CT) angiography are first line noninvasive tests available while invasive tests such as coronary angiography and intravascular ultrasound are second line diagnostic alternatives. Treatment approaches are still controversial and election of the optimal surgical procedure, whenever applicable, must be an individualized and patient-centered decision.