Anomalous left main coronary artery arising from the right sinus of Valsalva in a patient presenting with exercise-induced angina and syncope

A 68-year-old woman was admitted with complaints of palpitations and syncope of recent onset. She was suffering from exercise-induced angina for three years. Coronary angiography revealed no signs of atherosclerotic coronary artery disease, but an anomalous course of the left main coronary artery (LMCA) arising from the right sinus of Valsalva and passing between the pulmonary trunk and the ascending aorta. Ventriculography showed significant mitral regurgitation. Based on these findings, mitral valve replacement and prophylactic bypass surgery were recommended. Like in the presented case, prophylactic surgery may be considered in the presence of the interarterial course of the LMCA.