Perfusion Study Helps in the Management of the Intraseptal Course of an Anomalous Coronary Artery

Abstract

Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.

Surgical treatment of anomalous left main coronary artery with an intraconal course

“…There are several recent case reports that shed some additional light on the clinical presentation of anomalous LMCA with an intraconal course. One such case report summarized an experience with an 11‐year‐old male who was asymptomatic but had an echocardiogram as part of a sports screening program . This study revealed the presence of an anomalous LMCA.…”

Pulmonary Root Mobilization and Modified Lecompte Maneuver for Transseptal Course of the Left Main Coronary Artery

“…Nuclear scintigraphy may be useful to demonstrate myocardial perfusion deficit, which may help guide treatment as suggested. 4 Surgical technique is challenging due to the unusual course and many are not familiar with it.…”

Congenital coronary artery anomalies in sports medicine. Why to know them

“…22 The same is deemed valid for the anomalous origin of left common trunk or the left anterior descending coronary artery alone from the inappropriate sinus running through the conal septum (intraseptal, intraconal, or intramyocardial), 7,23 although not all authors agree on its "absolute" benignity, as inducible myocardial ischemia and even cardiac arrest has been reported in single cases. 24,25 In addition, Doan et al…”

“…Other anomalies, such as a coronary artery arising from the opposite sinus but traveling anterior to the pulmonary artery (pre‐pulmonic) or posterior to the aorta (posterior/retroaortic), are generally considered benign 22 . The same is deemed valid for the anomalous origin of left common trunk or the left anterior descending coronary artery alone from the inappropriate sinus running through the conal septum (intraseptal, intraconal, or intramyocardial), 7,23 although not all authors agree on its “absolute” benignity, as inducible myocardial ischemia and even cardiac arrest has been reported in single cases 24,25 . In addition, Doan et al reported inducible myocardial ischemia during stress test in up to 50% of patients with intraseptal anomalous aortic origin of a coronary artery 26 and even proposed a novel surgical approach to treat this condition 27 …”