Unstable angina pectoris, Aneurysm, Aortico-left ventricular tunnel, Extrinsic compression, Case report, Science (General), Q1-390, Social sciences (General), H1-99

Aortico-left ventricular tunnel (ALVT) is a rare congenital disease characterised by extracardiac channel communication between the ascending aorta and the ventricle. However, there have been no reports of ALVT compressing the coronary arteries. Here, we report the case of a 57-year-old woman who presented with unstable angina due to right coronary artery compression caused by a giant aneurysmal ALVT. Preoperative imaging failed to accurately diagnose this rare anomaly. Finally, we combined surgical exploration and a three-dimensional reconstruction technique to diagnose ALVT. After surgical resection of the aneurysm and repair of the tunnel, the patient's angina resolved. This case illustrates the importance of recognising extrinsic compression of the coronary artery as a potential cause of angina pectoris. It also highlights that ALVT with atypical anatomical features may require multiple imaging techniques and even surgical exploration to confirm the diagnosis.