Left main coronary anomalies of the right ventricular sinus in patients with aortic failure due to the web sub-aortic: A case report

Coronary artery anomalies are reported to have a higher incidence in young victims of sudden cardiac arrest (4-15%), as compared to adults (1%). Among coronary anomalies, anomalous coronary artery arising from the opposite sinus of Valsalva (ACAOS) remains a major clinical problem which poses daunting challenges. The current paper reports on the first case with main left coronary anomalies with aortic failure due to the web sub-aortic. A 29-year-old woman with orthopnea referred to a doctor. Echocardiography and electrocardiogram (ECG) confirmed sub aortic web with severe aortic insufficiency. Subsequently, the patient was subjected to aortic valve replacement surgery and the subvalvular resection was performed. During the surgery, the aorta was initially opened and the left coronary hole was not found in the coronary sinus. Therefore, only a cardioplegia from the right coronary (artery) hole was administered to the patient. The cusps of the valve and subvalvular web were removed. During the release, the left main artery which apparently originated from the right coronary artery(RCA) was found to be damaged. Therefore, the damaged part of the left main coronary artery was repaired, the valve was placed, and the aorta was repaired. Following deaeration, cross-clamp was removed, and the right heart started to work; nonetheless, the left heart was not engaged in any activity. Therefore, the cross-clump was attached again to the aorta, and a vein graft on the left anterior descending (LAD) artery was placed on the aorta. After the removal of the cross-clamp, the heart recovered its normal function, and the patient was removed from the pump with low inotropic. Thereafter, she was transferred to the Intensive Care Unit (ICU) of open-heart surgery. The present report aimed to express the incidence of multiple complications, such as recurrence of illness, the optimal time for surgery, the best way of surgery, getting cardiologists' attention (colleagues) during angiography, and knowing the characteristics of these abnormalities.