title: Anomalous coronary artery causing transmural ischaemia and ventricular tachycardia in a high school athlete.
abstract: 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.
authors.affiliation: 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
authors.forename: Caio Brito
authors.initials: CB
authors.lastname: Vianna
authors.forename: Maria Margarita
authors.initials: MM
authors.lastname: Gonzalez
authors.forename: Luis Alberto
authors.initials: LA
authors.lastname: Dallan
authors.forename: Afonso Akio
authors.initials: AA
authors.lastname: Shiozaki
authors.forename: Fabio Morais
authors.initials: FM
authors.lastname: Medeiros
authors.forename: Pedro Carrusca
authors.initials: PC
authors.lastname: Britto
authors.forename: Luiz Antonio
authors.initials: LA
authors.lastname: Cesar
mesh_terms: 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
chemical_list: D003287:Contrast Media