Aberrant left main coronary artery (ALMCA) arising from the right sinus with interarterial course

Case contributed by Fabien Ho


Dyspnea and mild chest pain on exertion. Routine echocardiogram performed by pediatric cardiologist raised suspicion of coronary anomaly.

Patient Data

Age: 15 years
Gender: Male

Left main artery arising from the right anterior sinus (ALMCA) with an interarterial course; mild stenosis is seen along its entire course between pulmonary trunk and aorta. The common left main artery then trifurcates into a left marginal artery, the anterior interventricular artery, and the circumflex artery.

Right coronary dominance.

Case Discussion

In patients with this condition, there is a markedly increased risk of sudden cardiac death and myocardial infarction upon exertion due to the interarterial course of the left main coronary artery.

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