Surgical therapy of an aberrant origin of the left anterior descending coronary artery from the right sinus of Valsalva: A case report

Anomalous aortic origin of a coronary artery from the incorrect coronary sinus of Valsalva is a rare congenital cardiac defect that is associated with an increased risk of sudden death. In most of these defects, the anomalous coronary artery takes an intramural course between the great arteries and leaves the aortic wall from the appropriate coronary sinus of Valsalva. Many times this anomalous artery shares a common orifice with the other coronary artery. We report on a previously healthy 15-year-old boy who presented with signs of an anterolateral myocardial infarction after physical activity (soccer game). Transthoracic echocardiography revealed an aberrant origin of the left anterior descending coronary artery from the right sinus of Valsalva. Repair was accomplished by unroofing the intramural segment. Because the intramural segment was below the commissure, detachment of the intercoronary commissure was not necessary. To conclude, transthoracic echocardiography can accurately depict this rare anomaly, and in symptomatic patients surgical therapy is indicated.