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The presence of a hypoplastic coronary is a relatively rare condition and it is seldom reported. Hypoplastic coronary can lead to severe ischemic consequences and appears to be poorly sensitive to invasive treatment. The case of a patient evaluated by transthoracic echocardiographic ultrasound (TTE-US) of the coronary tree is here reported. A poor visualization of the left anterior descending (LAD) coronary, generally well visible by this technique was noted. A few months later the patient underwent a myocardial infarction (MI) in the LAD territory. The coronary angiogram noted a hypoplastic LAD, poorly expanded by the stent. This finding was confirmed by repeated US,

The potential implication of this case report is that a more frequent use of a coronary TTE-US evaluation may at times indicate the presence of a poorly visible major coronary. The presence of a hypoplastic coronary artery should be considered.