[Anterior myocardial infarction associated with anomalous origin of the left main coronary artery]
Ana Livia Martínez-Raga1, Werner Schlie-Villa1, Marisol Martínez-Galindo1
1Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Cardiología. Ciudad de México, México.
Insights
A rare coronary artery anomaly, where the left coronary artery originates from the right sinus of Valsalva, was identified in a patient with myocardial infarction and thrombotic occlusion. This case highlights diagnostic challenges posed by such anatomical variations.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Anatomical Variations
Background:
- Coronary artery anomalies involve abnormal origin or course of epicardial arteries.
- The anomalous origin of the left coronary artery from the right sinus of Valsalva is a rare condition.
- Awareness of these variations is crucial for cardiologists during diagnosis and intervention.
Observation:
- A 69-year-old man presented with ST-elevation myocardial infarction.
- Coronary angiography revealed the left coronary artery originating from the right sinus of Valsalva.
- The left anterior descending artery had thrombotic occlusion, successfully treated with stenting.
Findings:
- Computed tomography confirmed the anomalous left coronary artery origin from the right sinus of Valsalva.
- The anomalous artery coursed anteriorly and laterally to the right ventricle.
- The patient experienced acute coronary syndrome despite the rare anomaly.
Implications:
- Anomalous coronary origins can increase the risk of ischemia and sudden cardiac death.
- This case underscores the diagnostic and interventional challenges presented by anatomical coronary variations.
- Prompt recognition and management are vital for patients with coronary anomalies and acute coronary events.
Background:
Coronary anomalies are those conditions characterized by the abnormal origin or course of the epicardial arteries. This generates challenges at the time of diagnosis by catheterization, which is why it is important that the cardiologist is related to these variations. The origin of the left coronary artery in the right sinus of Valsalva has a low incidence. It is reported the case of a patient with myocardial infarction who presented this anomaly with total thrombotic occlusion.
Clinical Case:
69-year-old man who presented myocardial infarction with ST segment elevation in the anteroseptal region. The catheterization reported left coronary artery with anterior origin and the right coronary sinus. The anterior descending artery presented thrombotic occlusion, which is why a stent was placed successfully. Subsequently, the tomography of the coronary arteries confirmed the anomalous origin of the left coronary artery from the right sinus of Valsalva, with a lateral and anterior course to the right ventricle.
Conclusions:
Patients with anomalous origin of the coronary arteries are exposed to greater events of ischemia and sudden death. However, some patients present with no previous history of acute coronary syndrome associated with thrombotic occlusion, which can represent a diagnostic challenge at the time of catheterization and coronary intervention due to the anatomic variability they may present.
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