Percutaneous treatment of an anomalous left main arising from the opposite sinus with subpulmonic course

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) is a rare congenital heart defect.
• ACAOS with an interarterial course is traditionally considered high-risk.
• Recent studies suggest a potentially protective effect in the low interarterial subtype.

Observation:

• A case of anomalous origin of the left coronary artery from the right coronary sinus presenting with anterior myocardial ischemia is described.
• The patient underwent an IVUS-guided percutaneous coronary intervention.
• IVUS provided detailed anatomical information and facilitated treatment guidance.

Findings:

• IVUS imaging is valuable in defining the precise anomalous coronary artery course.
• It aids in accurate individual risk stratification for patients with ACAOS.
• Percutaneous intervention guided by IVUS can be a viable treatment option.

Implications:

• Complementary imaging techniques, including IVUS, are recommended for managing ACAOS.
• Accurate assessment of the anomalous vessel's course is crucial for determining patient risk.
• IVUS can serve as a useful tool to guide therapeutic interventions in ACAOS.
• This case underscores the utility of advanced imaging in managing complex coronary anomalies.