Anomalous origin of the left circumflex artery from the pulmonary artery associated with non-compaction of the left ventricle: Usefulness of Multimodality Imaging – a case report

Introduction Anomalous origin of the left circumflex artery from the pulmonary artery (ACXAPA) is a very rare coronary anomaly. Only a few cases have been reported until today, from incidental findings to autopsy report after sudden cardiac death. Case We report here for the first time the case of a man, previously monitored for asymptomatic left ventricular non-compaction cardiomyopathy (LVNC), who presented with non-ST myocardial infarction, and was diagnosed with ACXAPA. Complementary tests confirmed ischemia in the corresponding territory and the patient was referred to surgery for reimplantation of the circumflex artery. Discussion LVNC is a rare congenital cardiomyopathy whose association with coronary anomalies, but not with ACXAPA, had previously been described until now. A related embryological origin could potentially explain this association. The management of a coronary anomaly should indicate dedicated multimodal cardiac imaging in order to not disregard the association with an underlying cardiomyopathy.