Common origin of right and left coronary arteries from the region of left sinus of Valsalva: association with unexpected intrauterine fetal death

Unexpected sudden death resulting from anomalous origin of the left coronary artery from the right sinus of Valsalva

Sudden death accounts for a large proportion of nontraumatic deaths. These deaths represent a considerable financial and emotional burden to the community, especially when they occur in younger age groups. One case of a 14-year-old man, who suddenly collapsed and died while playing soccer at school is shown. A complete medicolegal autopsy was performed, including toxicological analysis and microscopic examinations. During the necropsy, an study anomalous origin of the left coronary artery originating from the right Valsalva's sinus was noted. The present article discusses the possible relationship between this finding and sudden death.

Anomalous origin of the right coronary artery from the left aortic sinus and sudden infant death

The origin of the right coronary artery from the left aortic sinus is an uncommon anomaly, which has been shown to be a cause of sudden cardiac death in young and adult patients, often in association with physical exertion. So far, to the best of our knowledge, only six cases of sudden death related to this anomaly have been reported in newborns and infants. We describe here a further case which reinforces the need of precise postmortem examination in these fatalities.

Anomalous coronary arteries: a multicenter pediatric autopsy study

Anomalous coronary arteries (ACAs) are a potential cause of myocardial ischemia resulting in arrhythmias, angina, infarction, and sudden death. We analyzed 7857 pediatric autopsy cases from four tertiary centers to gain an overall picture of the range and significance of ACAs within this pediatric autopsy population. The incidence of ACAs was 0.5%, with ectopic origin from the aorta (43%) being most frequent, followed by ACA arising from the pulmonary trunk (40%). The mean age at death was 2.2 years (4 h-14 years). ACAs were associated with other anomalies in 57% of cases, 43% of these being cardiac defects. Growth retardation was noted in 50% of the cases. Examination of the heart showed cardiomegaly in 92% of cases, which was marked (> 95 percentile) in 63%, but histologically apparent ischemic damage was seen in only 50% of cases. ACAs arising from the pulmonary trunk were associated with earlier death (1.4 years), more frequent cardiomegaly (100%), and more frequent myocardial scarring (92%) than other types of anomalies. Although the terminal presentation was sudden death in 45% of cases, ACAs associated with other cardiac defects presented mainly with problems related to the latter anomalies. The results highlight the need to examine coronary arteries carefully during the pediatric autopsy. Not only are the positions of the coronary artery ostia important, but also the variations in the angles of arterial take-off, initial courses through the aortic adventitia, subsequent courses, and presence of ostial ridges or membranes that may result in significant compromise of blood flow.

Sudden death in pregnancy from congenital malformation of the coronary arteries

We report the case of a 40 yr old previously healthy woman who died suddenly during her second pregnancy from unusual coronary artery anomalies. The left anterior descending coronary artery arose from the above of the right sinus of Valsalva 1.1 cm above the ridge in the aorta and coursed behind the pulmonary valve before it dipped deeply into the myocardium of the interventricular septum. The left circumflex coronary artery was hypoplastic. The right coronary artery arose also from above the right sinus of Valsalva 1.1 cm above the ridge in the aorta but was otherwise normal. A fourth small coronary artery arose between the origins of the left anterior descending and right coronary artery and supplied the outflow tract of the right ventricle. Mild fibrosis was present in the interventricular septum. The rest of the autopsy examination was unremarkable. Such combination of coronary artery anomalies causing sudden unexpected death in a pregnant woman have not previously been reported.

Anomalous origin of the right coronary artery from the left sinus of Valsalva

A 1-month-old boy without precedent clinical signs of heart disease died unexpectedly. At autopsy, the child was found to have origin of the right coronary artery from the left sinus of Valsalva immediately leftward to the thickening of the aortic wall at the cuspal commissure and adjacent to the ostium of the left main coronary artery. The association of this coronary anomaly with otherwise unexplained prenatal or early postnatal death has only recently been appreciated as a potential cause of sudden infant death and mimic of sepsis, dysrhythmias, congestive heart failure, or metabolic storage diseases.

Normal and anomalous coronary arteries: definitions and classification

Results of a comprehensive survey of the literature concerning coronary artery anatomy, embryology, and pathophysiology show the lack of an adequate definition of normal coronary arteries. To fill this gap, the present review considers the available data concerning the embryogenesis of the coronary arteries and proposes a new definition of normality that refers to essential anatomic features. The concepts of normal variant versus anomaly are introduced, based on a statistical definition of the normal range (99% of the presentations observed in a normal, unselected population). Coronary anomalies are defined as those patterns found in less than 1% of the cases. The wide spectrum of coronary abnormalities is then organized according to a comprehensive classification scheme. For clinical purposes the conceptual difference between anatomic and pathophysiologic anomalies is stressed. The current paucity of experimental studies concerning normal and abnormal embryogenesis of the coronary arteries is found to be the major limitation to an understanding of this subject.