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case_images: Electrocardiogram from automated external defibrillator.
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case_images: The patient was immediately connected to automated external defibrillator pads and shock was delivered due to VF (Figure 1).
case_images: Electrocardiogram at initial presentation.
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case_images: Few minutes later, ECG was obtained by the paramedics arriving at the scene showing sinus tachycardia with antero-lateral ST-segment elevation and QS waves in leads V1, V2, I, and AVL (Figure 2).
case_images: Transthoracic echocardiography:left ventricle diastolic dimensions.
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case_images: Initial transthoracic echocardiography (TTE) showed severe and diffuse left ventricular (LV) dysfunction and dilatation with giant RCA (Supplementary material online, Videos S1 and S2; Figure 3).
case_images: Computed tomography imaging of the coronary tree. (A) 3D rendering of the heart, showing the ectatic right coronary artery which supplies blood to the whole coronary tree. (B) A maximal intensity projection of the origins of the coronary arteries: the right coronary artery originating from the aorta and the left main originating from the left pulmonary artery.
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case_images: An ECG-gated cardiac computed tomography confirmed the diagnosis of anomalous left main originating from the left PA (Figure 4).
case_images: MRI imaging. MRI imaging showing extensive sub-endocardial scarring involving the papillary muscles, anterior and lateral segments. (A) Native T1 mapping with elevated T1 values. (B) Post-contrast T1 mapping, which shows sub-endocardial gadolinium uptake in the anterior and lateral segments. (C) and (D) show extensive late gadolinium uptake representing extensive sub-endocardial scarring.
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case_images: No right ventricle involvement, no other valvular dysfunction, or PA dilation was noted (Figure 5).