Anomalous origin of left coronary artery from right sinus of Valsalva with unusual course

Excerpt

A 26-year-old male patient was admitted to the emergency department with the preliminary diagnosis of acute coronary syndrome. The patient had suddenly fallen to the ground when jogging in the morning; he had stopped breathing and resuscitation was performed by a bystander. The patient was intubated and cardiac rhythm was restored after resuscitation for about 45 min by the emergency staff. He had no known cardiovascular risk factors and no family history of sudden cardiac death. On physical examination, his general condition was poor, he was unconscious, was not breathing, and was mechanically ventilated. His blood pressure was 100/60 mmHg with intravenous administration of 10 ug/kg/min dopamine. Electrocardiography showed 3-mm ST-segment elevation in lead aVR suggestive of left main coronary artery lesion and ventricular tachycardia secondary to R-on-T phenomenon. The left main coronary artery could not be selectively cannulated in the left sinus of Valsalva. The dominant right coronary artery was correctly localized in the right sinus of Valsalva (Fig. 1 and Video 1a). It was found that a short coronary artery was originating from near the right coronary ostium and was divided into two branches: the left anterior descending artery and the left circumflex artery (Fig. 1 and Video 1b). Further evaluation revealed that the left anterior descending artery had an interarterial course and that the left circumflex artery had a retroaortic course (Fig. 2 and Video 2a, Fig. 2 b). No atherosclerotic lesions were observed. The patient was transferred to the intensive care unit to receive supportive care. Five hours after transfer to the intensive care unit, the patient developed asystole, did not respond to resuscitation, and died. …