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Case Reports
. 2008;35(2):162-5.

Ectopic origin of left coronary ostium from left ventricle, with occlusive membrane: a previously unreported anomaly, with an embryologic interpretation

Luigi Pirelli  1 , Pey-Jen Yu, Monvadi B Srichai, Katherine Khvilivitzky, Paolo Angelini, Juan B Grau
Affiliations
Case Reports

Ectopic origin of left coronary ostium from left ventricle, with occlusive membrane: a previously unreported anomaly, with an embryologic interpretation

Luigi Pirelli et al. Tex Heart Inst J. 2008.

Abstract

Congenital atresia of the left main coronary artery, a condition in which the left main trunk is developed but has been occluded since birth, is a rare coronary anomaly. Herein, we describe this anomaly's association with a subannular location of an obliterated left main ostium in a patient with a bicuspid aortic valve and severe aortic stenosis. The patient underwent successful surgery. We discuss the embryologic implications of congenital atresia of the left main coronary artery, in view of the exceptional anatomic features of this condition. To our knowledge, this is the 1st report of a left coronary artery that was found to arise from the left ventricle.

Keywords: Aortic stenosis, supravalvular/complications/diagnosis/surgery; coronary disease/classification/congenital/diagnosis; coronary vessel anomalies/classification/complications/diagnosis/pathology/surgery; echocardiography; heart defects, congenital/diagnosis/pathology/surgery.

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Figures

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Fig. 1 Preoperative coronary angiogram (right anterior oblique projection) shows 3 intraseptal collateral vessels arising from the right coronary artery (RCA) and supplying the left coronary arterial system.
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Fig. 2 Preoperative coronary angiogram (left anterior oblique projection) shows collateral filling of the proximal left coronary arterial system via intraseptal collateral vessels.
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Fig. 3 Intraoperative photograph, taken after the retrograde administration of cardioplegic solution, shows the out-pouching of the subannular membrane (arrowheads) that covers the left main coronary ostium. LVOT = left ventricular outflow tract
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Fig. 4 Postoperative coronary magnetic resonance angiogram shows the subannular origin of the left coronary artery ostium and the normal origin of the right coronary artery. AV = aortic valve; LCA = left coronary artery; LV = left ventricle; LVOT = left ventricular outflow tract; RCA = right coronary artery; RV = right ventricle
See this image and copyright information in PMC

References

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