Abstract
The pathophysiological mechanism for sudden death in patients with anomalous origin of the left coronary artery remains controversial. Common features in the reported cases include the course of the anomalous artery, between the aorta and the pulmonary artery, and the sudden death occurring during, or soon after, exercise.1 The original proposed mechanism for sudden coronary death in these patients postulated external vessel compression,2,3 although we would accept that abnormalities of the coronary ostium have since been identified.4 These may be treated by surgical deangulation,5 although the long-term success of these corrective procedures remains to be established. We would support the avoidance of strenuous activity before any proposed surgical intervention.
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