Abstract
RATIONALE: The left anomalous coronary artery originating from the opposite sinus represents a distinct subtype of anomalous coronary arteries originating from the opposite sinus. A comprehensive overview encompassing clinical characteristics, diagnostic approaches, and treatment modalities for this condition is presented herein. PATIENT CONCERNS: The patient, a 17-year-old female, was admitted to the hospital due to chest pain and syncope following multiple exercises. DIAGNOSES: After conducting an electrocardiogram, myocardial injury markers, and echocardiography, she was diagnosed with acute myocardial infarction complicated by syncope. Further examinations including coronary angiography, coronary computed tomography angiography, and cardiac magnetic resonance imaging revealed an anomalous origin of the coronary artery with the left coronary artery (LCA) arising from the right sinus and exhibited intramural course. INTERVENTIONS: The coronary "unroofing" technique was admitted according to her characteristics. The patient achieved successful recovery after surgery with no recurrence of chest pain or syncope during 1 year of follow-up. OUTCOMES: Anomalous origin of the LCA is a rare congenital anatomical anomaly. Surgical intervention represents the primary approach for subsequent management of symptomatic anomalous origin of the coronary artery. Importantly, individuals with anomalous origin of the LCA from the right coronary sinus are at potential risk of sudden cardiac death. LESSONS: Therefore, enhancing diagnostic precision and actively pursuing surgical treatment in confirmed diagnoses can effectively mitigate myocardial ischemia and prevent instances of sudden cardiac death among adolescents and athletes.