case_images: PMC10853022_01
case_images: (a) Transthoracic echocardiography (parasternal short axis) at initial examination. The origin of pain in the left coronary artery is not detected in its normal position. (b) Coronary computed tomography angiography (CCTA, three-dimensional reconstruction) depicting the left coronary artery originating from the right sinus of Valsalva. (c) CCTA shows that part of the left main coronary artery trunk runs between the aorta and pulmonary artery. (d) Measurements of the take-off angle from the ascending aorta in the left coronary artery. The solid line indicates the so-called ostium line, and the dashed line indicates the line drawn from the midpoint of the ostium line to a point along the center of the left main trunk. The angle between the two lines at the midpoint is measured as the take-off angle and is 22 degrees. Ao: aorta; PA: pulmonary artery; LCA: left coronary artery; RCA: right coronary artery; RCC: right coronary cusp; Left main coronary trunk.
case_images: CRIPE2024-6390066.001.jpg
case_images: PMC10853022_01_CRIPE2024-6390066.001.jpg
case_images: fig1
case_images: Based on this information, we suspected cardiogenic syncope and performed echocardiography, which failed to identify the origin of pain in the left coronary artery in its normal position (Figure 1(a)). Coronary computed tomography angiography (CCTA) demonstrated that the origin of the left coronary artery was located in the right sinus of Valsalva, and part of the left main trunk was intramural (Figures 1(b) and 1(c)). The left coronary artery had a very acute take-off angle from the aorta and the ostium was slit-like (Figure 1(d)).
case_images: Transthoracic echocardiography (a) and computed tomography angiography (b, c) 6 months after surgery showing the new left coronary ostium with unroofing of the intramural portion and patch enlargement using the great saphenous vein graft (red circles). Ao: aorta; PA: pulmonary artery; LMT: left main coronary artery trunk; LCC: left coronary cusp; RCC: right coronary cusp.
case_images: CRIPE2024-6390066.002.jpg
case_images: PMC10853022_01_CRIPE2024-6390066.002.jpg
case_images: fig2
case_images: The new left coronary artery orifice was slightly narrowed and subsequently augmented via patch enlargement by using a great saphenous vein graft (Figure 2).