Unusual congenital coronary artery anomaly in a young adult presenting as sudden cardiac arrest

Abstract

A previously asymptomatic young female with no previous medical or cardiac history collapsed during indoor exercise. A portable automatic external defibrillator showed a shockable rhythm. She received multiple electrical shocks with return to normal sinus rhythm without ischaemic ECG changes. Her troponin level was mildly elevated. A transthoracic echocardiogram revealed moderately reduced left ventricular ejection fraction with global hypokinesis. During emergent coronary angiography, the left main coronary artery could not be found. The right coronary artery was normal with robust collaterals to the entire left coronary circulation extending to the left main coronary artery, but did not fill the ostium. Coronary CT angiogram confirmed nearly complete absence of the left main coronary artery ostium. A diagnosis of left main coronary artery atresia was made. Patient underwent successful two vessel coronary artery bypass grafting. She continues to do well 1 year postoperatively.

Effects of Prehospital Factors on Survival of Out-Of-Hospital Cardiac Arrest Patients: Age-Dependent Patterns

“…Young adults generally have more OHCA due to coronary artery disease (CAD) than younger groups, and more OHCA due to genetic factors than older groups. Young adults generally have more OHCA due to CAD than younger groups, and more OHCA due to genetic factors than older groups [ 37 , 38 , 39 ]. Therefore, the patterns of impact of the first responder, bystander CPR, and AED use are located between the younger and the older.…”

Independent origin of anterior interventricular and left marginal arteries from the left posterior aortic sinus

“…A recent study from Thailand by Kultida et al (2018) [4] has reported the absence of the left main coronary artery and left circumflex artery in 0.4% cases. Cortes et al (2018) [5] have recently reported a case of congenital absence of left coronary artery, causing a sudden cardiac arrest during indoor exercise. A case of congenital absence of left circumflex artery with the presence of a super dominant right coronary artery has also been reported [6].…”

Congenital atresia of left main coronary artery

“…Clinical diagnosis of LMCAA might be neglected due to the wide range of nonspecific presenting symptoms including chest pain in a young patient, dyspnea, syncope or aborted sudden cardiac death 2, 5, 6, 7. Patients could remain asymptomatic for a long time due to a well development collateral system.…”