Anomalous Separate Origin of Left Anterior Descending Coronary Artery: Presented as Acute Anterior Myocardial Infarction
A 59-year-old man with hypertension and type 2 diabetes mellitus visited our emergency room with chest pain that had been started 2 hours prior to his visit. His electrocardiogram showed ST-segment elevation on lead V 1-4 (). The initial serum Troponin was normal. Total creatine kinase (CK) was elevated to a peak of 4145 Units/L and the CK-MB fraction was 419 ng/mL. An emergency CAG was performed through the right radial artery using a Judkins left catheter. The CAG showed a normal right coronary artery (RCA) and a normal LCX, but no visualization of the LAD. Initially, we considered that the ostium of LAD was totally occluded, but a guide wire could not pass the site through to the LAD ostium (). On repeated angiography from the coronary sinus, fortunately we found the separate LAD ostium directly from the left coronary aortic sinus beside the LCX ostium without the left main trunk (). There was total occlusion at the proximal LAD. After balloon angioplasty, there was 60% stenosis at the middle LAD (). We deployed a stent in the proximal LAD. For the demonstration of precise anatomical course and correlation of coronary arteries, coronary computed tomography (CT) angiography was performed with 64-row multidetector CT. It showed an absence of a left main trunk with an anomalous separate origin of LAD and LCX from left coronary aortic sinus ().