Cho Jonathan J, Fabrizio Samantha D, Tabing Ariana K, Boswell Gilbert E, Condos Gregory J
Department of Internal Medicine, Naval Medical Center San Diego, San Diego, CA 92134, USA.
Department of Radiology, Naval Medical Center San Diego, San Diego, CA 92134, USA.
Mil Med. 2023 Jul 22;188(7-8). doi: 10.1093/milmed/usab563. Epub 2022 Jan 7.
Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital abnormality associated with myocardial ischemia and sudden cardiac death. We present a case of a 20 year old previously healthy male presenting with exertional syncope and non-ST elevation myocardial infarction. Coronary computed tomography angiography showed an anomalous left main coronary artery arising from the right coronary cusp with a slit-like appearance, acute angle origin, intramural course, and a subsequent inter-arterial course between the main pulmonary artery and the proximal aorta. Cardiac magnetic resonance imaging demonstrated myocardial infarction in the distribution of the left main coronary artery. The patient underwent successful surgical correction with unroofing of the left main coronary artery. He has had no syncopal episodes or recurrence of chest pain and returned to full duty status in the United States Marine Corps. This case report demonstrates the evaluation and management of a patient with AAOCA.
冠状动脉异常起源于主动脉（AAOCA）是一种罕见的先天性异常，与心肌缺血和心源性猝死相关。我们报告一例20岁既往健康男性，表现为劳力性晕厥和非ST段抬高型心肌梗死。冠状动脉计算机断层扫描血管造影显示左主干冠状动脉起源于右冠状动脉窦，呈裂隙样外观，锐角起源，壁内走行，随后在主肺动脉和近端主动脉之间走行于动脉间。心脏磁共振成像显示左主干冠状动脉分布区域有心肌梗死。患者接受了左主干冠状动脉开窗的成功手术矫正。他没有再发生晕厥或胸痛复发，并恢复了在美国海军陆战队的全职工作状态。本病例报告展示了AAOCA患者的评估和管理。
