Multimodality Imaging Assessment of Anomalous Aortic Origin of the Left Main Coronary Artery Presenting With Syncope

Jonathan J Cho1, Samantha D Fabrizio2, Ariana K Tabing3

  • 1Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA.

Military Medicine
|January 11, 2022
PubMed

Insights

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect. Surgical unroofing successfully treated a young Marine with exertional syncope and myocardial infarction caused by AAOCA.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Cardiac Surgery

Background:

  • Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect.
  • AAOCA can lead to myocardial ischemia and sudden cardiac death.
  • Symptoms include exertional syncope and myocardial infarction.

Purpose of the Study:

  • To present a case of AAOCA in a young adult.
  • To describe the diagnostic evaluation and management of this condition.
  • To highlight successful surgical correction and patient outcomes.

Main Methods:

  • Coronary computed tomography angiography (CCTA) for anatomical assessment.
  • Cardiac magnetic resonance imaging (CMR) for myocardial viability.
  • Surgical unroofing of the anomalous left main coronary artery.

Main Results:

  • A 20-year-old male presented with exertional syncope and non-ST elevation myocardial infarction.
  • CCTA revealed an anomalous left main coronary artery with an inter-arterial course.
  • CMR confirmed myocardial infarction; surgical unroofing resulted in symptom resolution.

Conclusions:

  • AAOCA requires prompt diagnosis and management.
  • Surgical unroofing is an effective treatment for symptomatic AAOCA.
  • Successful surgical correction allows return to full duty.

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
40
Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
72
Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

Aneurysm II: Clinical Manifestations and Diagnostic Studies

Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
43
Imaging Studies for Cardiovascular System IV: CMRI01:21

Imaging Studies for Cardiovascular System IV: CMRI

Cardiovascular magnetic resonance imaging, or CMRI, is a non-invasive diagnostic test that employs a magnetic field and radiofrequency waves to create precise images of the heart and arteries. It provides comprehensive information about cardiac anatomy, function, perfusion, and tissue characterization without ionizing radiation.IndicationsCMRI diagnoses various heart conditions, including tissue damage from heart attacks, ischemic heart disease, myocarditis, aortic issues (tears, aneurysms,...
153
Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
42
Angina III: Clinical Manifestations and Assessment01:29

Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
47