Anomalous left coronary artery presenting with out-of-hospital cardiac arrest: a malignant outcome for a ‘benign’ variant

Abstract

BackgroundAnomalous left coronary arteries are rare congenital defects. These are often detected incidentally unless they have a malignant course whereby patients present with acute coronary syndromes. We describe a rare presentation of a benign variant of this pathology and a proposed diagnostic and management plan.Case presentationA 41-year-old female was admitted following an out-of-hospital cardiac arrest. Cardiac imaging demonstrated an anomalous left main coronary artery arising from a single right coronary ostium with a trans-septal course and associated ischaemic changes on functional testing. Given her clinical presentation, she underwent successful left coronary reimplantation surgery.ConclusionsThis case highlights that even supposedly ‘benign’ variants can have malignant outcomes and that functional testing can be useful in further risk-stratifying anomalous coronary anatomy. Surgical reimplantation is a feasible and effective treatment for achieving optimal long-term results