Intramural course of an anomalous left coronary artery is not always associated with a slit-like ostium

Area of Science:

• Cardiology
• Congenital Heart Disease
• Sports Cardiology

Background:

• Anomalous aortic origin of the left coronary artery (AAOLCA) is a significant cause of sudden cardiac arrest in young athletes.
• Intramural course of the left coronary artery is a high-risk morphology often associated with specific imaging findings.

Purpose of the Study:

• To report an unusual case of AAOLCA with an intramural course that lacked typical pre-operative imaging features.
• To emphasize the importance of considering intramural course despite atypical imaging findings.

Main Methods:

• Review of pre-operative cardiac imaging.
• Intraoperative inspection and surgical intervention (unroofing procedure).
• Post-operative imaging assessment.

Main Results:

• Pre-operative imaging showed a round ostium and luminal shape, suggesting no intramural course.
• Intraoperative inspection revealed a long intramural course of the left coronary artery.
• A successful unroofing procedure was performed, creating a new ostium from the correct aortic sinus.

Conclusions:

• Atypical imaging findings should not exclude the possibility of an intramural course in AAOLCA.
• Surgical unroofing can be a successful treatment for AAOLCA with intramural course, even in unusual presentations.