ST-segment elevation myocardial infarction in a patient with anomalous origin of left circumflex coronary artery.

We present a case of ST-segment elevation myocardial infarction in the territory of an anomalous left circumflex coronary artery running through the retroaortic region. In vivo coronary imaging with intravascular ultrasound visualized the usual atherosclerotic change and subsequent plaque rupture and thrombus formation at the culprit lesion. The clarification of pathologic mechanisms underlying the myocardial infarction case could provide information about pathophysiology of atherosclerotic development in anomalous left circumflex coronary artery, and could help in decision-making regarding the management strategy.

Objective: Intravascular ultrasound (IVUS) imaging indicated that ordinary atherosclerosis could develop at retroaortic anomalous course of left circumflex coronary artery (LCX) despite absence of mechanical cause of ischemia. IVUS screening could provide significant information about pathophysiology of atherosclerotic development in anomalous LCX, and could help in decision-making regarding the management strategy. The images and discussion have high educational value for clinical cardiologists alike.>.