Spontaneous Coronary Artery Dissection in Complex Congenital Coronary Anatomy

Spontaneous coronary artery dissection is a nonatherosclerotic cause of acute coronary syndrome, predominantly affecting women. Congenital coronary artery anomalies are uncommon but may confer mechanical and hemodynamic vulnerability.

We report the case of a 63-year-old woman presenting with acute coronary syndrome in the setting of a rare congenital anatomy, with origin of all 3 coronary arteries from the right coronary sinus. Angiographic and computed tomography findings were consistent with spontaneous coronary artery dissection.

Multimodality imaging was essential for defining coronary anatomy, delineating the extent of dissection, and guiding management. A conservative strategy was adopted, given preserved coronary flow and hemodynamic stability, resulting in favorable clinical evolution.

This case represents an exceptionally rare presentation of spontaneous coronary artery dissection in the setting of such complex coronary anatomy and underscores the importance of recognizing these cases by using multimodality imaging to avoid potentially harmful interventions.