Congenital atresia of left coronary ostium

A two-year-old girl, who presented with congestive heart failure and an extensive anterolateral infarction, was thought to have anomalous origin of the left coronary artery from the pulmonary artery. She improved rapidly and remained symptom free until 13 years of age, when she died suddenly. At necropsy the right coronary artery was found to be normal but in the left aortic sinus a dimple was the only remnant of the left coronary ostium. The proximal segment of the left long term follow-up of a patient with this rare anomaly.