937 INCIDENTAL DIAGNOSIS OF ANOMALOUS ORIGIN AF A CORONARY ARTERY: BETTER LATE THAN NEVER.

Abstract Background Anomalous origin of the left circumflex coronary artery (LCx) from right sinus Valsalva (RSV) is most frequent among anomalous aortic arteries (AAOCA). The estimated prevalence low (about 0.4%) and in cases asymptomatic. Angina, shortness breath, myocardial infarction has been described some patients, although diagnostic therapeutic management controversial, particularly elderly patients. Case presentation A 76-year-old female patient was admitted to our outpatient clinic for dyspnea chest discomfort. In clinical history hypertension, dyslipidemia diabetes were documented. Hemodynamic parameters, examination ECG normal. Transthoracic echocardiography showed preserved global systolic function without abnormalities regional kinesis valvular diseases excluded. Interestingly, five chambers apical view, a binary structure atrioventricular groove above mitral valve plane that seemed cross aorta perpendicularly (RAC sign) detected. Furthermore, parasternal short axis we visualized origins coronaries blood vessel behind root, as well small circle below non-coronary cusp mitroaortic angle long view (Bleb identified. We hypothesized an LCx RSV with retroaortic course this confirmed by computed tomography (coroCT), excluded intramural critical stenosis arteries. Finally, decided perform exercise stress which inducible ischemia. Pharmacological therapy optimized follow-up unremarkable. Conclusions AAOCA may be incidentally diagnosed also advanced age. Specific echocardiographic signs should suggest more imaging techniques confirm suspect. Non-invasive multimodality crucial, order exclude ischemia avoid invasive harmful tests.