A twisted tale

We present a case of a young healthy lady with anomalous coronary arteries who presented with cardiogenic syncope. She had a common origin of the left and right main coronary arteries from the right sinus of Valsalva with resultant malignant narrowing of the proximal 2 cm of the left main coronary artery due to extrinsic compression between the aorta and pulmonary artery. She underwent surgical correction that involved the creation of a new left main origin in the left coronary sinus with a 4mm punch. A short segment of the saphenous vein was anastomosed to this opening and then to the left main coronary artery and the original left main coronary artery was oversewn at the aorta.