Background: The association of two congenital coronary artery anomalies (CAAs) is extremely rare but represents one of the main cause of sudden cardiac death in young athletes. Although coronary angiography (CX-A) is still widely used in childhood, cardiac magnetic resonance (C-MRI) and cardiac computed tomography (C-CT) have recently taken on an increasing diagnostic role in early detection of CAAs and concomitant congenital cardiac malformations.
Case summary: A healthy 10-year-old male patient was referred to the Radiological Department of our Institution due to no evidence of left coronary artery in echocardiographic examination. With C-MRI was detected marked myocardial trabeculation and was suspected anomalous origin and course of left circumflex (LCx) artery and of left anterior descending (LAD) artery. With third generation Dual Source C-CT 192x2-sections (SOMATOM Force, Siemens, Germany) was confirmed anomalous origin of LCx artery from right pulmonary artery associated with anomalous origin of LAD artery from right coronary artery with course in front of right ventricular outflow tract. The patient underwent surgical treatment with reimplantation of the anomalous LCX and LAD arteries into the wall of ascending aorta, with no postoperative complications. The patient remained asymptomatic and follow-up C-MRI scan four months after operation showed complete success of surgery treatment.
Conclusion: This case highlights the diagnostic potential of C-CT and C-MRI in evaluation of CAAs and of cardiac morphology and functionality, with very low radiation dose and without the risks related to invasive procedure.
Keywords: Cardiac computed tomography; Cardiac magnetic resonance; Case report; Coronary anomalies; Coronary artery anomalies.