# Aberrant Left Coronary Artery Origin in a Patient Presenting With Acute Coronary Syndrome

## TL;DR

A 72-year-old patient with chest pain was found to have an unusual coronary artery structure and a severe artery blockage, which was treated with angioplasty.

## Contribution

This case report highlights a rare coronary artery anomaly and its clinical management in a patient with acute coronary syndrome.

## Key findings

- The patient had an aberrant left anterior descending artery and a severe right coronary artery lesion.
- Primary percutaneous coronary angioplasty successfully treated the right coronary artery blockage.
- CT angiography confirmed the abnormal artery structure and stent patency.

## Abstract

A congenital anomalous origin of the coronary artery is a rare cardiovascular malformation that includes the left circumflex artery arising from the right sinus of Valsalva (RSV), both coronary arteries arising from RSV, the left anterior descending (LAD) artery arising from the respiratory sinus arrhythmia, and a single coronary artery arising from the left sinus of Valsalva. We present the case of a 72-year-old patient presenting with chest pain to his local hospital while cycling. Troponin levels peaked from 90 to 360 ng/L, and electrocardiography showed normal sinus rhythm and left bundle branch block. Echocardiography showed good left ventricular function with an ejection fraction of 55% and no regional wall motion abnormalities. The patient underwent coronary angiography, which revealed a severe proximal right coronary artery (RCA) lesion and an aberrant LAD artery. He underwent primary percutaneous coronary angioplasty of the RCA and was discharged home with dual antiplatelet therapy and high-dose statins. CT coronary angiography revealed an aberrant LAD and patent RCA stent with mild to moderate disease in the distal vessel, and he was reviewed in the outpatient clinic.