Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva Associated with Syncope in a Young Athlete

Abstract

A 17-year-old African American boy had a syncopal event approximately 30 minutes after playing in a high school football game. He complained of headache just prior to losing consciousness but denied chest pain, dyspnea, or dizziness. His supine blood pressure was 114/69 mm Hg without orthostatic variation. The precordial examination was normal with a regular rhythm and no murmur. The electrocardiogram was normal. A transthoracic echocardiogram showed normal ventricular function and chamber sizes but demonstrated a possible abnormal origin of the right coronary artery (RCA). Computed tomographic coronary angiography (CTCA) confirmed that the RCA originated from the left sinus of Valsalva, a finding generally known as anomalous coronary artery from the opposite sinus (ACAOS). The RCA began adjacent to the ostium of the left main coronary artery, coursed between the aorta and pulmonary trunk, and had a characteristic “slit-like” ostial orifice (Figure). Figure Computed tomographic coronary angiography images of this patient with an anomalous right coronary artery (RCA) from the opposite sinus. (a, b) Images showing the origin of the RCA from the left sinus of Valsalva as it takes an interarterial course between ... Given this young patient's presentation of exertional syncope in the setting of right ACAOS, surgical correction was performed. The procedure involved “unroofing” the origin of the anomalous RCA and resuspending the aortic valve commissure, involving a total bypass pump time of 92 minutes. The patient recovered well and intended to resume activity in competitive sports.