ABSTRACT
In adulthood, congenital coronary artery anomalies represent more often as an incidental finding rather than the cause of clinical complaints. However, in some cases, congenital coronary anomalies may cause atypical chest pains, anginal pain, arrhythmias, sudden death or heart failure, even in adulthood. In patients with this coronary anomaly, the left coronary artery usually arises from the left posterior sinus of the pulmonary artery, rarely as far as the pulmonary artery trunk or branch. Its branching pattern is usually normal into left anterior descending and left circumflex arteries. While not usually dilated in childhood, an anomalous left coronary artery is usually tortuous, dilated and thin-walled in adulthood, and resembles a vein. A communication of a coronary artery with right-heart chambers creates a left-to-right shunt whose size is dependent on the fistula flow rate. In large fistulas, the shunt results in volume overload, right-heart chamber dilatation and increased pulmonary flow.
