Cardiovasc Imaging Asia.  2025 Apr;9(2):23-25. 10.22468/cvia.2025.00038.

A Case of Spontaneous Left Main Coronary Artery Spasm of Anomalous Origin of Left Main Coronary Artery

• Jang KT
• Oh JH
• Kim HS
• Lee HG

• KMID: 2568014
• DOI: http://doi.org/10.22468/cvia.2025.00038

Abstract

A 65-year-old male presented with chest pain that occurred after alcohol drinking at the early morning hours and relieved after taking sublingual nitroglycerin. Coronary angiography revealed a malformed left main coronary artery (LMCA) originating from the right sinus of Valsalva with 10%–20% stenosis and 80% vasospasm. Coronary artery spasm (CAS) in the LMCA is extremely rare but can present with catastrophic features. CAS is more frequently observed in atherosclerotic segments of coronary arteries, and multidetector computed tomography is preferred for assessing the degree of atherosclerosis in cases of LMCA spasm. Anomalous origin of coronary arteries (AOCA) is also rare but can lead to severe symptoms. Although surgical intervention is generally recommended for symptomatic patients, while management of asymptomatic cases remains a topic of ongoing research and debated. In this case, there was concern that the patient’s symptoms might be attributable to AOCA or CAS, medical management was selected over surgical intervention, given the presentation consistent with typical angina due to spasm.

Keyword

Left main coronary artery; Vasospasm; Anormalous origin; Coronary angiography