Korean Circ J.  2007 Jan;37(1):39-42. 10.4070/kcj.2007.37.1.39.

Anomalous Origin of the Left Coronary Artery Leading to Myocardial Infarction in a 14-year-old Boy

• Han JK
• Kim MS
• Kim SY
• Lee SE
• Kim HK
• Lee HY

• KMID: 2227092
• DOI: http://doi.org/10.4070/kcj.2007.37.1.39

Abstract

An anomalous origin of the coronary artery is an infrequent but significant cause of myocardial ischemia and sudden death. A left coronary artery arising from the right sinus of Valsalva is of clinical value due to its possible association with sudden cardiac death, particularly when it courses between the aorta and pulmonary trunks. Nevertheless, it is amenable to appropriate surgical intervention, thereby emphasizing the importance of clinical suspicion and timely identification. We report the case of a 14-year-old boy, who presented with acute myocardial infarction of the anterior wall, with an anomalous left coronary artery originating from the right sinus of Valsalva. Transthoracic echocardiographic evaluations of the anomalous origin of the coronary artery and Doppler finding of a 'finger-tip phenomenon', which can be observed under circumstances of myocardial bridging, allowed the diagnosis of this anomaly.

Keyword

Anomalous origin of coronary artery; Coronary vessel anomalies; Myocardial infarction

MeSH Terms

Adolescent*
Aorta
Coronary Vessel Anomalies
Coronary Vessels*
Death, Sudden
Death, Sudden, Cardiac
Diagnosis
Echocardiography
Humans
Male*
Myocardial Bridging
Myocardial Infarction*
Myocardial Ischemia
Sinus of Valsalva

Figure

• 

  Fig. 1 Electrocardiography shows findings consistent with acute anteroseptal myocardial infarction.

• 

  Fig. 2 Transthoracic echocardiography in the parasternal short axis view (A and B) shows an anomalous origin of the LCA, coursing via an "interarterial" pathway between the aorta and pulmonary trunks. Pulsed wave Doppler echocardiography (C) shows a normal coronary velocity pattern in the proximal left main coronary artery; whereas, a typical 'finger tip' phenomenon (arrow) can be observed in the distal left main coronary artery. Ao: aorta, PT: pulmonary trunks, LM: left main coronary artery, RCA: right coronary artery, LCA: left coronary artery.

• 

  Fig. 3 CT angiography (A and B) confirm the echocardiographic findings. Ao: aorta, PT: pulmonary trunks, LAD: left anterior descending artery, RCA: right coronary artery, LCx: left circumflex artery.

• 

  Fig. 4 99mTc-MIBI myocardial SPECT shows a reversible perfusion defect in the anterior, anteroseptal and anterolateral walls.

• 

  Fig. 5 Cardiac MRI, with delayed Gd-enhancement (right), shows the anterior and anteroseptal subendocardial infarction (arrow). LV: left ventricle.

Reference

1. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992. 20:640–647.

2. Lee KM, Lee MH, Kwon KH, et al. Acute myocardial infarction as a complication of anomalous left coronary artery origin from right coronary sinus. Korean Circ J. 1996. 26:901–908.

3. You YP, Lee YK, Yoon HS, Jeong KT, Park SC. Sudden death associated with anomalous left coronary artery origin from right sinus of Valsalva with posterior course. Korean Circ J. 2000. 30:1578–1582.

4. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000. 35:1493–1501.

5. Mirchandani S, Phoon CK. Management of anomalous coronary arteries from the contralateral sinus. Int J Cardiol. 2005. 102:383–389.

6. El-Menyar AA, Das KM, Al-Suwaidi J. Anomalous origin of the three coronary arteries from the right aortic sinus Valsalva: role of MDCT coronary angiography. Int J Cardiovasc Imaging. 2006. 22:723–729.

7. Roberts WC, Shirani J. The four subtypes of anomalous origin of the left main coronary artery from the right aortic sinus (or from the right coronary artery). Am J Cardiol. 1992. 70:119–121.

8. Kern MJ. The Cardiac Catheterization Handbook. 2003. 4th ed. Philadelphia: Mosby;256–258.

9. Cheitlin MD, de Castro CM, McAllister HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva, a not-so-minor congenital anomaly. Circulation. 1974. 50:780–787.

10. Pelliccia A, Spataro A, Maron BJ. Prospective echocardiographic screening for coronary artery anomalies in 1,360 elite competitive athletes. Am J Cardiol. 1993. 72:978–979.

11. Mohlenkamp S, Hort W, Ge J, Erbel R. Update on myocardial bridging. Circulation. 2002. 106:2616–2622.

12. Ghosh PK, Agarwal SK, Kumar R, Chandra N, Puri VK. Anomalous origin of right coronary artery from left aortic sinus. J Cardiovasc Surg. 1994. 35:65–70.