Anomalous Aortic Origin of Left Coronary Artery Leading to Sudden Cardiac Arrest in Young Female

Abstract

Purpose: Anomalous aortic origin of the coronary artery(AAOCA) is an uncommon but important cause of sudden death in young patients. Vigilance is required to ascertain a prompt diagnosis and expedite surgery to prevent further fatal events. We describe a case of a 20-year-old female with an anomalous left coronary artery origin, whose presentation and path to diagnosis and treatment is outlined. Methodology: A 20-year-old female presented following an out of hospital cardiac arrest (OOHCA) whilst swimming. ROSC was achieved with CPR and a single defibrillation from an AED. History revealed recurrent episodes of chest pain and syncope over the previous 4 years. She was evaluated 3 years prior by cardiology; TTE and EST were found to be normal and EP review for prolonged QTS stratified her as a low risk for QTS. She was discharged without further investigations. CTCA performed following her arrest revealed an anomalous left coronary artery, arising from the right coronary sinus, passing intramurally between the aortic root and pulmonary trunk. This was repaired by deroofing the left coronary artery across the top of the left and right commisure of the aortic valve. The aortic valve commisure was re-suspended with good outcome. Results: Surgery provided excellent immediate results and exercise stress test at 6 months was negative. She remained asymptomatic with no further episodes of chest pain or syncope and is now able to perform strenuous activities. Conclusion: The AAOCA arising from the opposite sinus of Valsalva is a rare but an important condition which targets children and adolescents with an often fatal outcome if diagnosis is missed.