Aborted Sudden Cardiac Death After Unroofing of Anomalous Left Coronary Artery

Area of Science:

• Cardiology
• Cardiac Surgery
• Congenital Heart Disease

Background:

• Anomalous left coronary artery (ALCA) is a rare congenital heart defect.
• Myocardial bridges can cause myocardial ischemia, especially when associated with coronary anomalies.
• Sudden cardiac death is a potential complication of uncorrected coronary artery anomalies.

Observation:

• A patient presented with recurrent aborted sudden cardiac death.
• The patient had an anomalous left coronary artery with an intramural course and an unrecognized myocardial bridge.
• Significant compression was noted at the left coronary artery ostium and myocardial bridge.

Findings:

• Intravascular ultrasound and fractional flow reserve revealed significant coronary ostial compression and myocardial bridging.
• Post-surgical intervention, including coronary translocation and myocardial bridge unroofing, normalized intravascular ultrasound and fractional flow reserve.
• The patient's symptoms resolved after surgical correction.

Implications:

• Comprehensive surgical planning is crucial for anomalous coronary arteries.
• Addressing all identified anatomical culprits, including myocardial bridges, is essential for successful outcomes.
• This case underscores the importance of thorough pre-operative assessment in managing complex coronary anomalies.