Sudden death associated with borderline Hypertrophic Cardiomyopathy and multiple coronary anomalies. Case report and literature review

Abstract

We report a case of sudden death in a 20 years old male who colapsed just minues after the beggining of a football training session. The autopsy evidenced the presence of a unique combination of coronary abnormalities: myocardial bridging at the level of both branches of the LCA; abnormal origin of the right coronary artery: 1 mm above the left semilunar valve of aorta; the initial segment of the RCA coursing within the aortic wall (0,7 cm); myocardial bridging at the level of LCX; sinoatrial node artery originated from the LCX. Histological examination revealed the presence of Hypertrophic Cardiomyopathy markers within the left ventricle and interventricular septum and the cumulative effects of the coronary cardiac anomalies on the myocardial blood flow: extensive interstitial and perivascular sclerolipomatosis, dissecting fibrosis at the level of the sinoatrial node, subendocardial hyaline fibrosis. 20 years old male, colapsed just several minues after the begining of a football training session. The ressuscitation attempts were unsuccesfull. He was recently transffered to a first league football team, and was considered a promissing goal keeper. The medical check-up, performed immediately after his transfer had not revealed any health problems. The autopsy evidenced several cardiac abnormal findings. The ostium of the right coronary artery (RCA) was identified above the left aortic sinus and the initial segment of the RCA coursed for 0.7 cm intramurally (fig. 3, 4), within the aortic wall, behind the pulmonary trunk (PT), before leaving the ascending aorta (AA) at the level of the right aortic sinus and finally resuming its normal position within the atrioventricular groove. RCA didn't give any branches until the posterior interventricular groove where, terminally, was divided in two branches: a short and threadlike one in the interventricular groove, and one which crossed over the left ventricle, after which it ended up in two short and threadlike branches on the diafragmatic face of the left ventricle. The main trunk of the left coronary artery (LCA) was 1 cm. long and coursed in the left part of the coronary groove, between the PT and the left atrial appendage (LAA); it was then divided into the anterior interventricular artery or left anterior descendent artery (LAD) and the circumflex artery (LCX). The initial segment of the LAD had a subepicardial trajectory within the anterior interventricular groove where the first diagonal branch of the left ventricle (LV) originated; in its course it went under two consecutive myocardial bridges, of 1.68 and, 2.22 cm respectively (fig. 1).