A rare coronary anomaly as a possible cause of ventricular tachycardia

Area of Science:

• Cardiology
• Anatomical Pathology
• Medical Imaging

Background:

• Coronary artery anomalies are congenital variations in the origin or course of coronary arteries.
• These anomalies can range from benign to life-threatening, often presenting diagnostic challenges.
• Early identification is crucial for appropriate management and prevention of adverse cardiac events.

Observation:

• A 77-year-old male presented with syncope due to sustained monomorphic ventricular tachycardia.
• Coronary angiography revealed an absent left main coronary artery with independent origins for the circumflex and anterior descending arteries from the right coronary sinus.
• Computed tomography with 3D reconstruction confirmed these findings, along with an interarterial path for the anterior descending artery and a retro-aortic path for the circumflex artery.

Findings:

• The patient had an unusual coronary artery anomaly characterized by the absence of the main coronary artery.
• Specific findings included independent ostial origins for the circumflex and anterior descending arteries, an interarterial course of the anterior descending artery, and a retro-aortic course of the circumflex artery.
• These anatomical variations were identified as an incidental finding during the workup for ventricular tachycardia.

Implications:

• This case underscores the diagnostic complexity of coronary artery anomalies, which are often discovered incidentally.
• Recognition of such rare anatomical variations is vital for understanding their potential contribution to cardiac arrhythmias, especially in younger patients.
• Implantation of an implantable cardioverter defibrillator provided secondary prevention, leading to a favorable outcome and discharge without incident.