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Case Reports
. 2022 Oct 26;18(1):4-7.
doi: 10.1016/j.radcr.2022.09.102. eCollection 2023 Jan.

STEMI in an adolescent boy due to anomalous left main coronary artery arising from the right sinus of Valsalva: Case report and brief review of the literature

Changcheng Li  1 , Wenyan Zhang  2 , Litao Zhang  1 , Yuanzhong Xie  1 , Xiujuan Li  1
Affiliations
Case Reports

STEMI in an adolescent boy due to anomalous left main coronary artery arising from the right sinus of Valsalva: Case report and brief review of the literature

Changcheng Li et al. Radiol Case Rep. .

Abstract

Congenital anomalous origin of coronary artery is a rare cardiovascular malformation and the most common anomaly is the left circumflex (LCX) arising from the right sinus of Valsalva (RSV). Other forms include both coronary arteries from RSV, the left anterior descending coronary artery from RSV, and a single coronary artery from the left sinus of Valsalva. Despite being rare, anomalous origin of left main coronary artery (LMCA) from RSV carries a high risk of sudden cardiac death. Here, we report a case of 13-year-old boy with chest pain and acute extensive anterior ST-segment elevation myocardial infarction (STEMI) who was initially diagnosed as acute myocarditis in the emergency department. A bedside echocardiogram showed severe global hypokinesia of left ventricle (LV) and normal right ventricle (RV) function. Coronary computed tomography angiography (CCTA) examination showed LMCA originated from the RSV. The patient underwent coronary artery bypass grafting surgery and was discharged without complications. A timely correct diagnosis of an anomalous coronary artery is critical in symptomatic patients, CCTA plays an important role in clinical decision making.

Keywords: Anomalous origin of coronary artery; Coronary computed tomography angiography; Myocardial infarction.

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Figures

Fig 1
Fig. 1
Anterior view of the 3-dimensional constructed computed tomography image of the heart (A) and axial view of the coronary computed tomography angiography (B) shows an anomalous origin of the left main coronary artery arising from the right coronary sinus; C (axial view) represents a malignant intra-arterial course between the aorta and main pulmonary artery with severe compression.
Fig 2
Fig. 2
Selective coronary angiography of the left coronary artery revealing the 90% stenosis in left main coronary artery (A and B).
See this image and copyright information in PMC

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