Anomalous left coronary artery in hypertrophic cardiomyopathy

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Hypertrophic cardiomyopathy (HCM) and anomalous coronary artery origin are significant risk factors for sudden cardiac death.
• Co-occurrence of these conditions is exceptionally rare in clinical reports.
• Left ventricular outflow tract (LVOT) obstruction is a common manifestation of HCM, often requiring intervention.

Observation:

• A 48-year-old woman presented with symptomatic LVOT obstruction due to HCM, refractory to medical management.
• Diagnostic workup revealed a rare coronary anomaly: a single coronary artery originating from the right sinus of Valsalva.
• The anomalous artery coursed between the aorta and the right ventricular outflow tract.

Findings:

• The patient underwent successful septal myectomy to alleviate LVOT obstruction.
• An implantable cardioverter-defibrillator (ICD) was placed for primary prevention of sudden cardiac death.
• The combined presence of HCM and anomalous coronary artery origin posed unique surgical and management challenges.

Implications:

• This case underscores the importance of comprehensive cardiac evaluation, including coronary imaging, in patients with HCM and LVOT obstruction.
• Management strategies must consider the anatomical complexities introduced by coexisting congenital coronary anomalies.
• Such rare presentations expand our understanding of the pathophysiology and therapeutic approaches for complex cardiomyopathies.