We report the case of a 63-year-old patient, admitted for NSTEMI, where the first examinations in ICU are in favor of a DCM with LV non-compaction associated with AAOCA, multimodal imaging will correct the final diagnosis by objectifying the CCTGA.

63-year-old patient, history of murmur and cardiomegaly without real follow-up or diagnosis, dyspnea on exertion for a few months, NYHA II, who presents a typical angina associated with a significant rise in cardiac biomarkers and is admitted in ICU for NSTEMI.

Mitral regurgitation murmur 2/6 th, under crackles at the bases.

ECG in wide LBBB, with bradycardia, axis in VR.

NT pro BNP high.

Pulmonary x-ray shows cardiomegaly with a rebounded left edge of the heart.

The echocardiography shows a dilated LV, very trabeculated, globular appearance, with a very wide range of non-compaction, a moderate mitral insufficiency (left valve), the operator noted in his report the impossibility to image well the aortic and pulmonary outflow tract (Fig. 1).

The patient has an angiogram which finds a weakly atheromatous network, however with AAOCA; birth of the LAD from the RCA and a very large and dominant CX giving 5 marginal branches of important caliber.

Subsequently, a CT scan and cardiac MRI were done.

First, the MRI, which finds a ventricle in a very trabecular systemic position and which clearly shows the mitro aortic rupture (major sign of TGA); as well as a wide range of late enhancement with some cryptic thrombis, the RV in the systemic position has an altered EF, LV in the upright position, with better systolic function (Fig. 2, Fig. 3).

And the CCTA that signs the NCVG with an anterior aortic birth and to the left of the PA (Fig. 4, Fig. 5).

The patient was treated with altered EF treatment (recommendations differ, however, on their effectiveness in CCTGA) with establishment of an ICD-CRT in a specialized center.