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Published on: July 21, 2023
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.
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.
Abstract:
Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital abnormality associated with myocardial ischemia and sudden cardiac death. We present a case of a 20 year old previously healthy male presenting with exertional syncope and non-ST elevation myocardial infarction. Coronary computed tomography angiography showed an anomalous left main coronary artery arising from the right coronary cusp with a slit-like appearance, acute angle origin, intramural course, and a subsequent inter-arterial course between the main pulmonary artery and the proximal aorta. Cardiac magnetic resonance imaging demonstrated myocardial infarction in the distribution of the left main coronary artery. The patient underwent successful surgical correction with unroofing of the left main coronary artery. He has had no syncopal episodes or recurrence of chest pain and returned to full duty status in the United States Marine Corps. This case report demonstrates the evaluation and management of a patient with AAOCA.
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