Anomalous left main coronary artery origin, silent ischaemia, risk of sudden death: a triad detected by combining coronary CT and dipyridamole SPECT

Sudden death is often the first manifestation of ALMCO. 2 In this patient, the aortic root dilation may have compressed the acute angle take off of the RCA, inducing a dynamic stenosis. 3 Perfusion may have then become dependent on collaterals. [...]dipyridamole-induced flow steal from RCA collaterals could not be ruled out for the genesis of the septal-inferior wall ischaemia. 4 In ALMCO, the decision for surgery must be balanced between the risk of sudden death decreasing with age, the presence of symptoms and the ischaemic territory involved. 5 As ischaemia was mild and asymptomatic, we decided to increase the patient's myocardial protection with [beta]-blockers and set up a simple annual surveillance.