Anomalous left main coronary artery causing a myocardial infarction in a 14-year-old boy

A 14-year-old boy presented with exertional chest pain and was found to have rising cardiac biomarkers. The electrocardiogram revealed ST-segment elevation and T-wave inversion in the anterolateral leads. Coronary arteriograms and coronary computed tomography (CCT) showed an anomalous left main coronary artery originating from the right coronary sinus of Valsalva and coursing intramurally within the wall of the aorta between the aorta and the pulmonary trunk. The proximal left main was narrow with normal distal left main, left anterior descending, and left circumflex coronary arteries. The patient underwent surgical de-roofing of the intramural course of the left main artery with relief of his symptoms. Coronary artery anomalies have been found in 1.3% of the patients in a large arteriographic study. These anomalies are classified on the basis of the origin of the coronary arteries, as well as their course and distribution. Many of these variations are discovered incidentally at arteriography or autopsy. However, some of the anomalies cause symptoms, and a few of them can cause sudden cardiac death, even at a young age.