Aborted sudden cardiac death associated with an anomalous right coronary artery

Area of Science:

• Cardiology
• Medical Imaging
• Sports Medicine

Background:

• Coronary artery anomalies originating from the opposite sinus of Valsalva with an interarterial course are a significant cause of sudden cardiac death in young athletes.
• Hypertrophic cardiomyopathy is the leading cause, but these anomalies are the second most common.
• The specific anomaly of the right coronary artery (RCA) arising from the aorta (AO) above the left sinus of Valsalva (LSV) is exceptionally rare.

Observation:

• A 64-slice multidetector coronary CT identified an extremely rare RCA anomaly.
• The RCA originated from the AO above the LSV.
• The anomalous RCA coursed between the aorta and pulmonary artery.

Findings:

• This is the first reported case of a right coronary artery originating from the aorta above the left sinus of Valsalva with an interarterial course.
• The anomaly was discovered in a patient who experienced ventricular fibrillation (VF) cardiac arrest during a marathon.

Implications:

• This case underscores the importance of recognizing rare coronary artery anomalies in athletes presenting with cardiac arrest.
• Advanced imaging techniques like coronary CT are crucial for diagnosing such life-threatening conditions.
• Understanding these anomalies can aid in risk stratification and prevention strategies for sudden cardiac death in athletic populations.