Coexisting Congenital Left and Right Coronary Artery Anomalies: A Rare Cause of Pediatric Cardiac Arrest

Congenital left main coronary artery atresia (LMCAA) is an extremely rare anomaly associated with a high risk of myocardial ischemia and sudden cardiac arrest.

We present the case of a 12-year-old boy who experienced a ventricular fibrillation arrest during exercise, primarily attributed to LMCAA with an anomalous right coronary artery (RCA) originating from the left aortic sinus considered as the potential contributing factor. Multimodal imaging was critical in diagnosis and surgical planning. The patient underwent successful surgical revascularization with left internal mammary artery grafting to the left anterior descending artery and unroofing of the anomalous RCA.

In children presenting with out of hospital cardiac arrest, accurate imaging for coronary artery anomalies remains paramount. The diagnosis of congenital LMCAA with an anomalous RCA (with high-risk features) represents a rare but potentially treatable cause.

The case underscores the importance of early recognition and intervention in rare congenital coronary artery anomalies.