# Coexisting Congenital Left and Right Coronary Artery Anomalies: A Rare Cause of Pediatric Cardiac Arrest

## TL;DR

A rare case of a 12-year-old boy with two congenital coronary artery anomalies led to cardiac arrest, but successful surgical treatment was possible with accurate imaging.

## Contribution

Highlights a rare coexistence of LMCAA and anomalous RCA as a treatable cause of pediatric cardiac arrest.

## Key findings

- Multimodal imaging was essential for diagnosing the coronary anomalies.
- Surgical revascularization and unroofing successfully treated the anomalies.
- Early recognition of such anomalies is crucial for preventing sudden cardiac arrest in children.

## Abstract

Congenital left main coronary artery atresia (LMCAA) is an extremely rare anomaly associated with a high risk of myocardial ischemia and sudden cardiac arrest.

We present the case of a 12-year-old boy who experienced a ventricular fibrillation arrest during exercise, primarily attributed to LMCAA with an anomalous right coronary artery (RCA) originating from the left aortic sinus considered as the potential contributing factor. Multimodal imaging was critical in diagnosis and surgical planning. The patient underwent successful surgical revascularization with left internal mammary artery grafting to the left anterior descending artery and unroofing of the anomalous RCA.

In children presenting with out of hospital cardiac arrest, accurate imaging for coronary artery anomalies remains paramount. The diagnosis of congenital LMCAA with an anomalous RCA (with high-risk features) represents a rare but potentially treatable cause.

The case underscores the importance of early recognition and intervention in rare congenital coronary artery anomalies.