CTICasesAnomalous Left Main Coronary Artery with Intramural Course
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Imaging findings
Coronary CT angiography shows a high origin of the left main coronary artery arising near or just above the sinotubular junction. There is severe slit-like narrowing of the proximal left main coronary artery along its short intramural segment, measuring approximately 3 mm. Soft tissue attenuation is visible surrounding this intramural portion. Post-operative MRI demonstrates resolved narrowing and no permanent ischemic cardiac or cerebral damage.
Key takeaways
An anomalous coronary artery with an intramural course runs within the adventitia of the aorta, making it vulnerable to compression and slit-like narrowing, especially during exercise-induced aortic expansion. This condition poses a high risk for malignant ventricular arrhythmias and sudden cardiac death in young athletes. Surgical correction typically involves an unroofing procedure to relieve the intramural segment.
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