Aberrant left coronary artery arising from the right sinus of Valsalva: case reports of a rare entity

Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course : Case report and review of the literature

Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised.

Potential for Using 3D Technology to Image the Origins of the Coronary Arteries

When young patients present to the echocardiography laboratory with chest pain, one consideration is that there may be an anomalous coronary artery. For this reason, it is critical that the sonographer evaluate the origins of the coronary arteries and map them with color Doppler flow to ensure that the blood is going in the correct direction. Although this may sound simple, not all sonographers have been trained to image the coronary arteries in detail and map them as far as possible. This pilot study investigated the feasibility of using volume acquisition from the parasternal short-axis and apical views. The results demonstrated that coronary artery origins can be successfully identified in adults using reconstruction of 3D volume data sets without adding significant time to the examination.