case_images: PMC5752982_01
case_images: (a) CT coronary angiography demonstrates normal aortic root (37 mm) and (b, c, and d) anomalous origin of the left main coronary artery from the right coronary Valsalva sinus with a pathway between the pulmonary artery and the aorta (white arrow). LM, left main coronary artery; LAD, left anterior descending; LCx, left circumflex artery; RCA, right coronary artery; RPD, right posterior descending artery; RVP, right posterior ventricular artery; DGLIS, diagonal branch; PT, pulmonary trunk; Ao, aorta.
case_images: CRIC2017-3861923.001.jpg
case_images: PMC5752982_01_CRIC2017-3861923.001.jpg
case_images: fig1
case_images: Computed Tomography (CT) coronary angiography revealed the left main coronary artery with anomalous origin from the right coronary Valsalva sinus and an initial pathway between the aorta and pulmonary arteries, where there was significant luminal reduction (close to 50%) at rest, absence of atherosclerosis or luminal reduction in the other coronary arteries, and total calcium score of zero (Figure 1).
case_images: (a, b) Coronary angiography without obstructive atherosclerotic plaques.
case_images: CRIC2017-3861923.002.jpg
case_images: PMC5752982_01_CRIC2017-3861923.002.jpg
case_images: fig2
case_images: CT coronary angiography analysis, it was not possible to define intramural coronary pathway existence and there was no intravascular ultrasonography available to improve diagnostic accuracy. Coronary angiography confirmed an anomalous origin of the left coronary artery, with exit from the right coronary sinus without obstructive lesions (Figure 2).
case_images: Sesta-MIBI perfusion scintigraphy showing discrete anterior wall perfusion defect (apical segment) and transient perfusion defect in the mild and basal segments of the anterior wall and in the middle segment of the anterolateral wall.
case_images: CRIC2017-3861923.003.jpg
case_images: PMC5752982_01_CRIC2017-3861923.003.jpg
case_images: fig3
case_images: Sesta-MIBI perfusion scintigraphy demonstrated left ventricular ejection fraction of 61% at rest, and 57% poststress, discrete anterior wall perfusion defect (apical segment), and mild transient perfusion defect in the middle and basal segments of the anterior wall and the segment of the anterolateral wall (Figure 3).