Surgical Unroofing for Anomalous Origin of a Coronary Artery: A Case Report

Abstract Anomalous origin of the coronary arteries refers to abnormalities in the number, location, or orientation of the coronary artery ostia. This condition is associated with an increased risk of misdiagnosis and sudden cardiac death. An 18-year-old male with no known cardiovascular risk factors who developed cardiogenic shock during exercise is presented. Diagnostic evaluation using cardiac ultrasound, coronary computed tomography angiography, and coronary angiography revealed that the left coronary artery originated high in the supra-sinus region on the anterior wall of the ascending aorta. The anomalous origin was close to the pulmonary trunk, resulting in compression and stenosis of the left main coronary artery. Surgery should be performed as soon as possible in those with ischemic symptoms such as syncope, angina, or potential risk factors for origin or route. Therefore, left coronary reshaping was performed using a surgical unroofing technique. The patient achieved a favorable long-term prognosis at 9-month follow-up, with normalization of left ventricular wall thickness, stable coronary ostial patency, and no recurrence of symptoms. This case indicates that timely surgical intervention can be a safe and effective option in the management of high-risk intramural anomalous left coronary artery, which may help lower the risk of sudden cardiac death and optimize clinical outcomes.