Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.
Keywords: anomalous aortic origin coronary artery (AAOCA); anomalous coronary artery arising from the opposite sinus (ACAOS); asymptomatic ischemia; congenital heart disease; intramyocardial course; intraseptal course; myocardial perfusion; stress test; sudden cardiac death.