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Case Reports
. 2025 Aug 8:12:1640534.
doi: 10.3389/fcvm.2025.1640534. eCollection 2025.

Case Report: Anomalous origin of the left main coronary artery arising from the left ventricular outflow tract

Huynh Thi Minh Thuy  1   2 , Tran Minh Bao Luan  2   3 , Pham Tho Tuan Anh  3 , Nguyen Hoang Dinh  2
Affiliations
Case Reports

Case Report: Anomalous origin of the left main coronary artery arising from the left ventricular outflow tract

Huynh Thi Minh Thuy et al. Front Cardiovasc Med. .

Abstract

An anomalous origin of the left main coronary artery arising from the left ventricular outflow tract is an exceedingly rare congenital coronary anomaly, typically associated with impaired myocardial perfusion. Here, we report the case of a 67-year-old asymptomatic woman in whom an anomalous origin of the left main coronary artery, arising from the left ventricular outflow tract below the aortic valve, was incidentally identified during routine preoperative cardiac evaluation. Despite the anatomical abnormality, the patient exhibited no clinical or imaging evidence of myocardial ischemia. This finding is likely explained by a marked dilation of the right coronary artery and the presence of well-developed collateral circulation supplying the left coronary system. With no evidence of ischemia and maintained ventricular function, a non-interventional approach was deemed appropriate. This case highlights the importance of comprehensive anatomical and functional assessment in detecting clinically silent coronary anomalies and underscores the value of advanced cardiac imaging in the preoperative evaluation of elderly patients undergoing non-cardiac procedures.

Keywords: anomalous origin of the coronary artery; congenital coronary artery; coronary angiography; coronary computed tomography angiography; left main coronary artery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Coronary computed tomography angiography shows the origin of the LMCA below the aortic valve (originating from the LVOT). (A) 3D CT reconstruction shows the LMCA origin below the aortic annular plane at the commissure between the left coronary cusp and the non-coronary cusp. (B) 3D CT reconstruction shows a dilated RCA and collateral circulation from the RCA to the left coronary system. (C) The LMCA originated below the aortic annular plane (green line). (D) Ostial narrowing and the intramural segment of LMCA measurements. (E) Relationship of LMCA trunk (yellow asterisk) and hypoplastic ostium (green arrow) to aortic valve annulus and aortic valve leaflets (yellow arrows). (F) LMCA-LAD artery course reconstruction. LM, left main coronary artery; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; CONUS, conus branch of the right coronary artery; AM, the acute marginal artery; PDA, posterior descending artery; PL, posterolateral branch artery.
Figure 2
Figure 2
Coronary angiography confirms the LMCA originating below the aortic annular plane, evidenced by retrograde contrast flow from the LMCA into the LVOT (orange arrows). LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery.
Figure 3
Figure 3
The timeline of the case.
See this image and copyright information in PMC

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