Left main coronary artery originating from the right sinus of Valsalva and coursing between the aorta and pulmonary trunk

Findings are described in five patients who at necropsy were found to have origin of the left main coronary artery from the right sinus of Valsalva and coursing of the anomalously arising artery between aorta and pulmonary trunk to reach the left side of the heart. Three of the five patients were boys and died suddenly at ages 13, 14 and 19 years, respectively: two of them had had one or more episodes of syncope and the third had an abnormal electrocardiogram. The fourth patient, a 64 year old woman, died of chronic congestive heart failure 1 year after an acute myocardial infarction. She had insignificant coronary atherosclerosis. The fifth patient, an 81 year old man, died of chronic alcoholism, having been free of symptoms of cardiac dysfunction during life. Additionally, clinical and necropsy findings are summarized in 38 previously reported necropsy patients with the coronary anomaly. Of these 38 (34 male [89%]), 23 (61%) died suddenly in the first two decades of life; death in 6 others (16%) appears to have been related to coronary atherosclerosis and 9 patients (24%) died from noncoronary causes. Thus, this anomaly is life-threatening. Why it frequently causes fatal cardiac arrest in some young individuals and allows a normal life span in others remains unclear.

This article has been cited by other articles:

				B. L. Meel An anomalous origin of left coronary artery and sudden death in a soccer player: a case report Med Sci Law, July 1, 2011; 51(3): 182 - 183. [Abstract] [Full Text] [PDF]

				M. Ali, A. Hanley, E. P. McFadden, and C. J. Vaughan Coronary artery anomalies: a practical approach to diagnosis and management Heart Asia, January 24, 2011; 3(1): 8 - 12. [Abstract] [Full Text] [PDF]

				R. A. Krasuski, D. Magyar, S. Hart, V. Kalahasti, R. Lorber, R. Hobbs, G. Pettersson, and E. Blackstone Long-Term Outcome and Impact of Surgery on Adults With Coronary Arteries Originating From the Opposite Coronary Cusp Circulation, January 18, 2011; 123(2): 154 - 162. [Abstract] [Full Text] [PDF]

				S. R. Veeram Reddy and H. R. Singh Chest Pain in Children and Adolescents Pediatr. Rev., January 1, 2010; 31(1): e1 - e9. [Full Text] [PDF]

				J.A. Brothers, M.G. McBride, B.S. Marino, R.S. Tomlinson, M.A. Seliem, M.H. Pampaloni, J.W. Gaynor, T.L. Spray, and S.M. Paridon Exercise performance and quality of life following surgical repair of anomalous aortic origin of a coronary artery in the pediatric population. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 380 - 384. [Abstract] [Full Text] [PDF]

				P. Angelini Coronary Artery Anomalies: An Entity in Search of an Identity Circulation, March 13, 2007; 115(10): 1296 - 1305. [Abstract] [Full Text] [PDF]

				J. D. Dodd, M. Ferencik, R. R. Liberthson, R. C. Cury, U. Hoffmann, T. J. Brady, and S. Abbara Congenital Anomalies of Coronary Artery Origin in Adults: 64-MDCT Appearance Am. J. Roentgenol., February 1, 2007; 188(2): W138 - W146. [Abstract] [Full Text] [PDF]

				C. S. White Invited commentary. RadioGraphics, March 1, 2006; 26(2): 333 - 334. [Full Text] [PDF]

				J. Datta, C. S. White, R. C. Gilkeson, C. A. Meyer, S. Kansal, M. L. Jani, R. C. Arildsen, and K. Read Anomalous Coronary Arteries in Adults: Depiction at Multi-Detector Row CT Angiography Radiology, June 1, 2005; 235(3): 812 - 818. [Abstract] [Full Text] [PDF]

				G. J. Balady Sudden Cardiac Death in Young Military Recruits: Guarding the Heart of a Soldier Ann Intern Med, December 7, 2004; 141(11): 882 - 884. [Full Text] [PDF]

				P. C. Frommelt, M. A. Frommelt, J. S. Tweddell, and R. D. B. Jaquiss Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course J. Am. Coll. Cardiol., July 2, 2003; 42(1): 148 - 154. [Abstract] [Full Text] [PDF]

				R. Khouzam, T. Marshall, D. Lowell, and J. R. Siler Left Coronary Artery Originating from Right Sinus of Valsalva with Diagnosis Confirmed by CT: A Case Report Angiology, July 1, 2003; 54(4): 499 - 502. [Abstract] [PDF]

				N. H. Bunce, C. H. Lorenz, J. Keegan, J. Lesser, E. M. Reyes, D. N. Firmin, and D. J. Pennell Coronary Artery Anomalies: Assessment with Free-breathing Three-dimensional Coronary MR Angiography Radiology, April 1, 2003; 227(1): 201 - 208. [Abstract] [Full Text] [PDF]

				C. Basso, B. J. Maron, D. Corrado, and G. Thiene Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1493 - 1501. [Abstract] [Full Text] [PDF]

				A. Dodge-Khatami, C. Mavroudis, and C. L. Backer Congenital Heart Surgery Nomenclature and Database Project: anomalies of the coronary arteries Ann. Thorac. Surg., April 1, 2000; 69(4): S270 - S297. [Abstract] [Full Text] [PDF]

				E R Schwarz, P K Hager, R Uebis, P Hanrath, and H G Klues Myocardial ischaemia in a case of a solitary coronary ostium in the right aortic sinus with retroaortic course of the left coronary artery: documentation of the underlying pathophysiological mechanisms of ischaemia by intracoronary Doppler and pressure measurements Heart, September 1, 1998; 80(3): 307 - 311. [Abstract] [Full Text]

				B. J. Maron, J. Shirani, L. C. Poliac, R. Mathenge, W. C. Roberts, and F. O. Mueller Sudden Death in Young Competitive Athletes: Clinical, Demographic, and Pathological Profiles JAMA, July 17, 1996; 276(3): 199 - 204. [Abstract] [PDF]

				D. Bucsenez, B. J. Messmer, A. Gillor, and G. von Bernuth Management of anomalous origin of the left coronary artery from the right sinus of Valsalva J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1370 - 1373. [Full Text]

				A. J. Cohen, B. A. Grishkin, R. A. Helsel, and H. D. Head Surgical therapy in the management of coronary anomalies: Emphasis on utility of internal mammary artery grafts Ann. Thorac. Surg., April 1, 1989; 47(4): 630 - 637. [Abstract] [PDF]