Approximately 0.3% to 2% of patients may have anomalous origins of the coronary arteries. Anomalous origin of the left coronary artery (LCA) or left anterior descending (LAD) artery from the right sinus has been well described. In persons in whom the course involves an interarterial track between the aorta (Ao) and pulmonary artery (PA), an increased incidence of sudden death has been reported, particularly during or shortly after exercise. This has been felt to be due to transient occlusion of the anomalous LAD from increased blood flow through the Ao and PA as the anomalous LAD courses between them, possibly causing myocardial ischemia. In an elective setting, further anatomic delineation with other methodologies such as cardiac magnetic resonance (MR) imaging is recommended. In this case report we present an emergent percutaneous coronary intervention (PCI) of an anomalous LAD arising from the right sinus of Valsalva and coursing between the Ao and PA in a nonsurgical candidate.
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