Congenital Absence of Left Main Coronary Artery with Anomalous Origin of Left Anterior Descending and Left Circumflex Arteries Presenting with Acute Non-ST Elevation Myocardial Infarction.

Mohammed Al-Sadawi,Arismendy Nunez Garcia,Jessica Celenza-Salvatore,Muhammad Ihsan,Muhammad Dogar,Samy I Mcfarlane

doi:10.12691/ajmcr-7-10-10

Mohammed Al-Sadawi, Arismendy Nunez Garcia + Show 4 more

Open Access

https://doi.org/10.12691/ajmcr-7-10-10

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Abstract

Congenital coronary artery anomalies are rare disease entities, occur only in 0.3%−5.6% of the general population. These anomalies could lead to serious complications in some cases and is associated with associated with sudden death due to lethal arrhythmias and premature coronary artery disease. Diagnosis of these anomalies is generally made during angiography. In this report, we present a rare case of absent left main coronary artery and anomalous origins of left anterior descending artery and left circumflex artery from right sinus of Valsalva in a 62 year old man presented with non-ST elevation myocardial infarction (NSTEMI).

Highlights

We are presenting a 62-year-old male who presented with non-ST non-ST elevation myocardial infarction (NSTEMI) who found to have anomalous absence of left main coronary artery and anomalous origins of left anterior descending artery and left circumflex artery from right sinus of Valsalva
Transthoracic echocardiography showed ejection fraction estimated to be 60% without wall motion abnormality. He was taken for cardiac catheterization, which showed 95% occlusion of proximal left circumflex artery (LCX) and 60% occlusion of distal Left anterior descending artery (LAD)
Studies suggest that congenital coronary artery anomalies are the second most common cause of sudden death in young athletes, likely due to premature coronary disease [2]

Summary

Introduction

Congenital coronary artery anomalies are defined as a coronary pattern that is found in less than 1% of the general population, with a prevalence ranging from 0.3%−5.6% [1]. Congenital absence of left main coronary artery (LMCA) and anomalous origins of left anterior descending artery (LAD) and left circumflex artery (LCX) arising from right sinus of Valsalva is rarely reported. We are presenting a 62-year-old male who presented with non-ST NSTEMI who found to have anomalous absence of left main coronary artery and anomalous origins of left anterior descending artery and left circumflex artery from right sinus of Valsalva. Electrocardiography showed tall positive T waves at inferior leads (Figure 1) His troponin was initially 0.5 ng/L increased after 4 hours to 1.2 ng/L. Transthoracic echocardiography showed ejection fraction estimated to be 60% without wall motion abnormality He was taken for cardiac catheterization, which showed 95% occlusion of proximal left circumflex artery (LCX) and 60% occlusion of distal Left anterior descending artery (LAD). He was discharged on aspirin and ticagrelor in a stable medical condition

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