A 41-year-old woman presented with a history of heart surgery at the age of 10 years for anomalous left coronary artery from the pulmonary artery. Reimplantation had been impossible and, in view of the high-grade collaterality from the right coronary artery, the surgeon had ligated the left main. Recovery had been uneventful and the woman remained asymptomatic for the next 30 years, with three full-term pregnancies and a full-time secretarial job. The patient was a former light smoker, with normal glycaemia and lipid profiles.
The patient had tried to take up physical exercise in 2008, but experienced typical chest pain at maximal effort when running. A stress test reached 110 W and became positive above 110 beats per minute. A single photon emission computed tomography scan ( Fig. 1 A ) revealed reversible anteroseptoapical ischaemia with a 14% estimated hypoperfusion index. Consequently, a coronary angiogram ( Fig. 1 B) was done with a view to surgical revascularization. The left ventricular ejection fraction was 0.63. The right coronary artery was free of visible atheroma and re-injected the left artery via multiple anastomoses ( Supplementary data ).
