Unusual congenital coronary anomaly and myocardial ischaemia

Area of Science:

• Cardiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Congenital coronary artery anomalies are rare and can lead to myocardial ischemia.
• Typical angina symptoms can be caused by coronary artery anomalies even without significant lumen narrowing.

Observation:

• A woman presented with typical angina and was diagnosed with a rare congenital coronary anomaly.
• All three coronary arteries originated from a single ostium in the right aortic sinus.
• The left anterior descending coronary artery had an unusual septal (intramuscular) course.

Findings:

• Angiography and transesophageal echocardiography confirmed the anomalous origin and course of the coronary arteries.
• Exercise testing reproduced angina with characteristic ECG changes and reversible anterior myocardial perfusion defects.
• Myocardial ischemia was specifically linked to the septal course of the left anterior descending artery, not other coronary artery disease.

Implications:

• This case highlights that myocardial ischemia can result from coronary anomalies with intramuscular courses, even without obstructive lesions.
• Understanding aberrant coronary artery anatomy is crucial for diagnosing and managing ischemic heart disease.
• Further research into the mechanisms of ischemia in coronary anomalies may improve patient outcomes.