Development of Myocardial Ischemia after Pulmonary Embolism in Anomalous Aortic Origin of Right Coronary Artery

Anomalous aortic origin of the right coronary artery from the left coronary sinus (AAORCA) is a relatively rare congenital heart anomaly and often clinically silent, but one of the major causes of sudden death in young people. It remains unclear when myocardial ischemia appears in AAORCA patients who previously have no findings of myocardial ischemia. We herein report a 34-year-old AAORCA patient who newly developed myocardial ischemia induced by acute pulmonary embolism (PE). The patient had presented chest pains and syncope attacks on exertion after the occurrence of PE although the thrombus had already disappeared. Exercise-stress electrocardiogram showed positive, and computed tomography revealed compressed AAORCA. Surgical re-implantation of the right coronary artery to the right cusp successfully improved myocardial ischemia. In conclusion, we should care appearance of myocardial ischemia in AAORCA patients especially when they develop PE. In addition, it is inferred that other diseases increasing pulmonary artery pressure may also induce myocardial ischemia in AAORCA patients. Key words: Anomalous Aortic Origin of Coronary Artery; Pulmonary Embolism; Myocardial Ischemi