Background:
Anomalous aortic origin of a coronary artery (AAOCA) is a rare and abnormal variant of the coronary artery. Management decisions are complex and are based on symptoms and the course of the artery.
Case:
A 36-year-old female presented with chest pain, troponin elevation, and T-wave inversions. Left heart catherization revealed the left main coronary artery (LMCA) originating from right coronary cusps (RCC) and 95% stenosis of the mid left anterior descending artery (LAD). Coronary computed tomography revealed an anomalous origin of the LMCA from the RCC with an inter-arterial course, compression and narrowing of the LMCA between the ascending aorta and pulmonary artery along with non-calcified plaque causing severe 95% mid LAD stenosis.
Decision-making:
Patient underwent percutaneous intervention to the LAD rather than CABG or an unroofing procedure as her symptoms were felt to be more likely attributable to the LAD stenosis rather than the inter-arterial anomalous LM. Her chest pain resolved postintervention. A subsequent exercise nuclear stress test demonstrated no ischemia.
Conclusion:
We describe a case in which a patient is found to have a rare AAOCA variant while experiencing chest pain with EKG changes. Her symptoms were successfully treated with PCI rather than CABG or an unroofing procedure, highlighting the importance of risk stratification when evaluating patients with AAOCA.
Footnotes
Poster Contributions
For exact presentation time, refer to the online ACC.22 Program Planner at https://www.abstractsonline.com/pp8/#!/10461
Session Title: Complex Clinical Cases: FIT Flatboard Poster Selections – Interventional and Structural
Abstract Category: FIT: Interventional and Structural
