Multimodal Imaging Directs Decision Making in Intraseptal L-AAOCA

Area of Science:

• Cardiology
• Congenital Heart Disease
• Cardiac Imaging

Background:

• Congenital coronary artery anomalies (CCAs) are uncommon causes of congenital heart disease.
• Intraseptal coronary artery courses have limited data regarding evaluation and management.
• CCAs carry a risk of sudden cardiac death, particularly in young individuals.

Observation:

• A 27-year-old woman presented with a single coronary trunk originating from the right sinus.
• The left main coronary artery had a 2.7 cm intraseptal course.
• She underwent stress cardiac magnetic resonance (CMR) and catheterization to assess for inducible ischemia.

Findings:

• The patient underwent successful surgical repair with transconal unroofing.
• Post-operative recovery was uneventful, with no residual symptoms.
• Multimodal imaging (CMR and catheterization) was crucial in guiding management decisions.

Implications:

• Comprehensive evaluation is essential for managing patients with CCAs.
• Further research is needed to establish optimal work-up, intervention indications, and timing.
• Multimodal imaging plays a critical role in diagnosing and managing CCAs, especially those presenting with exertional chest pain.