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Septal course of the left main coronary artery from right aortic sinus and ventricular tachycardia
S S Kothari1, K K Talwar, P Venugopal
1Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi. kothari@medinst.ernet.in
Insights
Anomalous left main coronary artery originating from the right aortic sinus and coursing through the septum can cause resistant ventricular tachycardia. Surgical bypass resolved the condition, highlighting that this anomaly is not always benign.
Area of Science:
- Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- Anomalous origin of the coronary arteries is a rare congenital heart defect.
- The left main coronary artery (LMCA) typically arises from the left aortic sinus.
- Anomalous LMCA origin can be associated with myocardial ischemia and sudden cardiac death.
Observation:
- A 42-year-old male presented with drug-resistant ventricular tachycardia.
- Diagnostic imaging revealed an anomalous origin of the LMCA from the right aortic sinus.
- The anomalous LMCA followed an intramyocardial course within the ventricular septum.
Findings:
- The patient's ventricular tachycardia resolved completely following a coronary artery bypass graft (CABG) procedure.
- The bypass graft supplied the otherwise normal left anterior descending and circumflex coronary arteries.
- Histopathological examination of the bypassed vessels was not detailed in the abstract.
Implications:
- This case underscores that an anomalous LMCA originating from the right aortic sinus with a septal course can be hemodynamically significant and symptomatic.
- It challenges the notion that such anomalies are invariably benign.
- Early diagnosis and appropriate surgical intervention, such as CABG, are crucial for managing associated arrhythmias and preventing adverse outcomes.
Abstract:
A 42-year-old man with resistant ventricular tachycardia was found to have an anomalous origin of the left main coronary artery from the right aortic sinus that pursued an intramyocardial course through the ventricular septum. The tachycardia resolved after coronary artery bypass graft to otherwise normal left anterior descending and circumflex coronary arteries. Septal course of an anomalous left main coronary artery from right aortic sinus should not always be considered benign.