A Rare Case Report on Coronary Artery Anomaly: from Embryology to Emergency

Dr. Arundhati Shingare, Dr. Ganesh Avhad

Abstract: Anomalous coronary artery origin is a rare congenital cardiac abnormality that can have significant clinical implications, particularly when associated with a "malignant" course. Among these anomalies, the anomalous origin of the Left Coronary Artery is particularly critical due to its vital role in myocardial perfusion. This condition is especially concerning when the Left Coronary Artery takes an interarterial course between the aorta and pulmonary artery-a trajectory termed "malignant" due to its association with sudden cardiac death (SCD), particularly in young athletes. Hereby, we present a case of a 73 year old male who presented with breathlessness on exertion since 1 month with a positive TMT. CT Coronary Angiography study revealed Anomalous origin of Left Main Coronary Artery (LMCA) from Right Coronary Artery (RCA) with a malignant course between the aorta and pulmonary artery followed by an intramural course. The study also showed Double Vessel Disease affecting the Left Circumflex Artery (LCx) and Right Coronary Artery (RCA).

Keywords: congenital cardiac abnormality, malignant course, sudden cardiac death