High-Risk Variant of a Rare Coronary Anomaly.

A 61-year-old man presented with typical chest pain and was treated via acute coronary syndrome protocol. Findings on his initial diagnostic evaluations prompted cardiac catheterization. His angiographic findings were suspicious for anomalous coronary artery origin. Advanced imaging confirmed an aberrant course of the left coronary artery, with the vessel arising from the right aortic sinus of Valsalva. It was identified that the patient possessed all known high-risk features associated with this anomaly, findings not previously documented in a living adult. The patient ultimately underwent surgical revascularization to mitigate his risk for sudden cardiac death.