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The left ‘coronary artery sandwich anomaly’ with cardiogenic syncope: a case report.
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  • Ye Zhu,
  • Yinhua chen,
  • Jia You,
  • Chao Xu,
  • Yong Chen,
  • Xiang Gu
Ye Zhu
Yangzhou University Medical college
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Yinhua chen
Yangzhou University Medical college
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Jia You
Northern Jiangsu People's Hospital
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Chao Xu
The University of Oklahoma Department of Biostatistics and Epidemiology
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Yong Chen
Yangzhou University Medical college
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Xiang Gu
Yangzhou University Medical college

Corresponding Author:[email protected]

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Abstract

Anomalous origin of coronary arteries is usually asymptomatic and a rare disease. However, some cases can cause severe life-threatening events such as myocardial infarction and syncope. Management of coronary anomalies continues to be a controversial topic in clinic, for which requires a high index of suspicion for timely diagnosis and management. We report a case of a 15-year-old symptomatic boy who presented with cardiogenic syncope and was diagnosed with a rare congenital “coronary artery sandwich anomaly” (CASA), acute subendocardial myocardial infarction and cardiac failure requiring extracorporeal membrane oxygenation(ECMO) for stabilization. Speckle tracking echocardiography examination showed decreased segmental ventricular wall motion and the left ventricular global longitudinal strain was -9.3%. Cardiac computed tomography (CT) showed that an anomalous origin of the left coronary artery arose from the right coronary sinus, with acute angle takeoff and inter-arterial course between aorta and pulmonary artery. Cardiac Magnetic Resonance Imaging(MRI) image showed: diffuse abnormal intima enhancement in the left ventricle, the left ventricle was enlarged and systolic function was decreased. The best treatment was coronary artery unroofing operation. However, the patient was with poor cardiac function and was managed with conservative treatment instead of operation. This case demonstrated that the left CASA with acute angle takeoff and inter-arterial course between the aorta and pulmonary artery is extremely rare but severe potentially life-threatening presentation which should be managed with a promptly and careful treatment. In this case, speckle tracking echocardiography, cardiac CT and MRI have played important roles in diagnosis and therapy of the disease.