Exercise-unrelated sudden death as the first event of anomalous origin of the left coronary artery from the right aortic sinus

Congenital anomalous origins of the coronary arteries represents a rare but well-described cause of myocardial ischemia and sudden death. Left coronary artery (LCA) arising from the right sinus of Valsalva is a rare congenital coronary anomaly that seems to be commonly associated with sudden death i...

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Bibliographic Details
Published in:The Journal of emergency medicine 2005-11, Vol.29 (4), p.437-441
Main Authors: De Rosa, Gabriella, Piastra, Marco, Pardeo, Manuela, Caresta, Elena, Capelli, Arnaldo
Format: Article
Language:English
Subjects:
anomalous origin of coronary artery
Child
children
Coronary Vessel Anomalies - physiopathology
Coronary Vessels - pathology
Death, Sudden, Cardiac - etiology
Exercise
Fatal Outcome
Female
Humans
pediatrics
Sinus of Valsalva - abnormalities
sudden cardiac death
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Summary:Congenital anomalous origins of the coronary arteries represents a rare but well-described cause of myocardial ischemia and sudden death. Left coronary artery (LCA) arising from the right sinus of Valsalva is a rare congenital coronary anomaly that seems to be commonly associated with sudden death in young trained athletes. The possibility of a coronary artery anomaly should always be considered in young individuals with a history of chest pain or syncope, particularly if the episodes are triggered by exercise. We describe a case of congenital LCA anomaly in an asymptomatic 10-year-old girl with no family history of sudden death; no previous unexplained syncopal episodes or exercise-induced symptoms were reported. She experienced a cardiac arrest while she was resting at school and was not recoverable despite early emergency department admission and intensive prolonged cardiopulmonary resuscitation attempts. Post-mortem pathological findings revealed a single origin from the right sinus of Valsalva for both right and left coronary arteries. The LCA was compressed between the aorta and the pulmonary trunk. Histologic features suggested recent ischemia. Although sudden death can be the first manifestation of this condition, it is important to be particularly aware of prodromic symptoms: exertional dyspnea, chest pain, syncope or dizziness. Recognition during life of this coronary anomaly is mandatory to prevent the risk of sudden death and to plan surgical correction if clinically indicated.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2005.07.001