Virginia Research Day 2021

Student Research Educational

05 Anomalous Left Main Coronary Artery with Concomitant Atherosclerotic Disease Treated with Angioplasty

Tyler Avery, OMS III; Dr. Christopher Bunn

Augusta Health Via College of Osteopathic Medicine-Virginia Campus

Anomalous left coronary artery arising from the right sinus of Valsalva are very rare variants reported to be as low as 0.047% of the general population. There are 4 courses that the left main coronary artery (LMCA) can take when anomalous with the most commonly diagnosed being the intraarterial due to its symptomatic nature from a compressive syndrome between an expanded aorta and pulmonary trunk causing angina during exertion. Symptomatic anomalous coronary vessels are to be treated by CABG or unroofing which is a 1b recommendation by the ACA/AHA. These anomalies most often present in young males with recurrent episodes of syncope related to exertion while playing collegiate sports or intense military training. Sudden cardiac death (SCD)

or sudden cardiac arrest (SCA) are both common presentations of an anomalous coronary vessel particular LCMA with intraarterial course. Patient X did not fit the classic presentation as a male in his late 50’s with no prior syncopal episodes presenting to the emergency department with the chief complaint of angina. Workup for SCA including echocardiogram demonstrated a likely lesion in the territory of the left circumflex artery (LCX). Angiography reveled an undiagnosed anomalous LMCA with anterior course explaining his lack of previous symptoms. Based on the previously performed echocardiogram the lesion was localized to the region of the LCX which further ruled out the possibility of a intraarterial lesion. The lesion in patient X’s case was determined

to be atherosclerotic which is not amendable by the recommended treatment of unroofing of the anomalous vessel. In this rare case based on clinical picture and associated imaging it was determined that the patient was a candidate for less invasive angioplasty intervention compared to the surgical techniques normally utilized. Repeat imaging in this now asymptotic male showed a <25% atherosclerotic lesion of the LCX in the setting of a patient with an anomalous LMCA coursing anteriorly and originating from the right sinus of Valsalva.

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