case_images: PMC10515559_01
case_images: The patient's ECG on admission showed flattening of the T-wave.. ECG: electrocardiogram.
case_images: 10.1177_2050313X231200150-fig1.jpg
case_images: PMC10515559_01_10.1177_2050313X231200150-fig1.jpg
case_images: fig1-2050313X231200150
case_images: An electrocardiogram (ECG) showed a normal sinus rhythm and normal axis, with flattening of the T-wave in precordial leads (Figure 1).
case_images: Multiple coronary angiographic views of the patient. (A) LAD from the right coronary cusp (RCC), (B) LCX from the right coronary cusp had a severe thrombotic stenosis in the mid portion, (C) right coronary artery (RCA) from the right coronary cusp, (D) an aortogram showed all three coronary arteries originating from the RCC.. LAD: left anterior descending; LCX: left circumflex.
case_images: 10.1177_2050313X231200150-fig2.jpg
case_images: PMC10515559_01_10.1177_2050313X231200150-fig2.jpg
case_images: fig2-2050313X231200150
case_images: CAG was done on the same day (day 0 after referral) and showed that the left anterior descending (LAD) and left circumflex (LCX) originated from the right cusp, and LCX had a severe thrombotic lesion in the distal part before the terminal portion with an acceptable runoff, which was determined to be the culprit lesion (Figure 2).
case_images: CCTA of the coronary arteries, which confirmed the diagnosis of ACAOS. (A) A multiplanar reconstruction of CCTA showed a single coronary ostium from the RCC trifurcating into the LAD, RCA, and LCX, with the intramuscular (trans-septal) course of the LAD and the retro-aortic course of the LCX. (B) A multiplanar reconstruction of CCTA also showed a short axis plane of the aortic root and the retro-aortic positioning of the LCX.. ACAOS: anomalous coronary artery from the opposite sinus of Valsalva; CCTA: coronary computed tomography angiography; LAD: left anterior descending; LCX: left circumflex; RCA: right coronary artery; RCC: right coronary cusp.
case_images: 10.1177_2050313X231200150-fig3.jpg
case_images: PMC10515559_01_10.1177_2050313X231200150-fig3.jpg
case_images: fig3-2050313X231200150
case_images: Additionally, the proximal part of the LAD had a trans-septal (intermuscular) course and the LCX had a retro-aortic course (Figure 3).