Myocardial Ischaemia Secondary to Anomalous Aortic Origin of the Left Main Coronary Artery

Coronary Artery Anomalies (CAAs) are a heterogenous group of congenital disorders with an increasing incidence. Affected patients may present with a spectrum of symptoms reflective of myocardial ischaemia, depending on blood flow through the anomalous coronary artery and therefore myocardial supply. We present a case of a positive echocardiographic stress test in a patient with significant cardiovascular disease risk factors, who was subsequently found to have anomalous origin of the left main coronary artery arising from the right coronary cusp and running a malignant course between the aorta and the main pulmonary trunk. She later underwent re-diversion of the left main coronary artery to the left coronary sinus, and autologous pericardial patch to remnant stump of LMCA with symptom resolution.