Abstract
Anomalous coronary artery from the opposite sinus of Valsalva (ACAOS) is a rare congenital condition with reported incidence of 1.07%. It is classically associated with risk for sudden death (SCD) based on autopsy reports. Several anatomic features of this anomaly have been correlated with its symptomatology and risk of SCD, and surgical revascularization has been suggested by guidelines. However, based on recent reviews, SCD risk in ACAOS patients may be overestimated and that these patients may be managed conservatively. We present a case of a 53-year-old athletic Filipino male who consulted for sudden chest heaviness after a basketball game. He was initially managed as a case of acute coronary syndrome. However, subsequent coronary angiography revealed an anomalous right coronary artery arising from the left coronary sinus. Coronary computed tomography angiography showed an acute angle take-off of the right coronary artery with an interarterial course between the pulmonary artery and the aorta. The patient was managed conservatively with good outcomes. The patient’s management and a review of literature on ACAOS are reported in this paper. KEYWORDS: ACAOS, coronary artery anomaly, sudden cardiac death.
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