Anomalous coronary artery causing transmural ischaemia and ventricular tachycardia in a high school athlete.
A previously asymptomatic 15-year-old boy was treated at our institution after an episode of chest pain, palpitation, and syncope while playing in a high school soccer game. The patient's resting electrocardiogram was normal. A transthoracic echocardiogram showed an anomalous left main coronary artery originating from the right sinus of Valsalva. Contrast-enhanced multidetector computed tomography demonstrated clearly that the anomalous vessel coursed between the aorta and the pulmonary trunk (interarterial subtype). Treadmill testing registered several nonsustained polymorphic ventricular tachycardias and transmural myocardial ischaemia in the early recovery phase (ST-elevation up to 5mm in CM5 and V2 leads). The patient underwent bypass grafting. One year later, he remains asymptomatic, and new treadmill tests have been normal. In this patient, severe transmural myocardial ischaemia was detected, possibly due to collapse or vasospasm of the anomalous vessel, triggering life-threatening ventricular arrhythmias.
Vianna
Caio Brito
CB
Heart Institute (InCor), University of São Paulo Medical School, 44 Doutor Eneas Carvalho Aguiar, São Paulo, SP 05403.900, Brazil. caio.vianna@incor.usp.br
Gonzalez
Maria Margarita
MM
Dallan
Luis Alberto
LA
Shiozaki
Afonso Akio
AA
Medeiros
Fabio Morais
FM
Britto
Pedro Carrusca
PC
Cesar
Luiz Antonio
LA
D000293:Adolescent; D003287:Contrast Media; D001026:Coronary Artery Bypass; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012850:Sinus of Valsalva / Q000002:abnormalities; D012916:Soccer; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D003287:Contrast Media