Transcatheter Aortic Valve Implantation with Anomalous Left Main Origin From Right Coronary Cusp: A Case Report

BACKGROUND Transcatheter aortic valve implantation (TAVI) is a less invasive option for severe aortic stenosis in patients unfit for surgery. Its use has substantially expanded due to its safety profile and clinical efficacy in appropriately selected patients. This report highlights the procedural challenges of managing aortic stenosis in the presence of a rare coronary anomaly. The anomalous origin of the left main coronary artery from the right coronary cusp is uncommon but clinically important because of the potential for adverse outcomes during intervention. This anomaly may increase the risk of coronary obstruction or compromise during valve deployment. Accurate identification and risk mitigation strategies are essential to prevent complications in such cases. CASE REPORT A 70-year-old woman with aortic stenosis was evaluated for progressive exertional dyspnea. Diagnostic echocardiography confirmed severe aortic stenosis. Further assessment with cardiac computed tomography and cardiac catheterization revealed an anomalous origin of the left main coronary artery from the right coronary cusp; no obstructive lesions were identified. The patient successfully underwent TAVI, guided by detailed imaging that informed valve selection and procedural planning to address challenges posed by her unique coronary anatomy. Postprocedural recovery was uneventful, and the patient demonstrated substantial symptomatic improvement at follow-up. CONCLUSIONS This case demonstrates the feasibility and safety of performing TAVI in patients with coronary anomalies. It underscores the importance of precise imaging, coronary protection strategies, and individualized procedural planning to achieve optimal clinical outcomes. Further studies are warranted to develop standardized approaches for managing anatomically complex cases.