Anomalous origin and course of coronary arteries: a case report

A clinical case of great importance for sports medicine regarding an anomalous origin of the coronary arteries with the presence of a single coronary arising from the right sinus of Valsalva and left coronary with interarterial course between aorta and pulmonary artery is reported. The patient, aged 16, was a competitive footballer and was completely asymptomatic. The anatomical anomaly is fairly rare and the variation with interarterial course reported here places it among the so-called malignant sub-types owing to the possibly dramatic sequelae, among which sudden death, especially among the young. The ECG at rest showed an aspecific anomaly characterised by a fight axial deviation of the axis. A control transthoracic echocardiography showed an anomalous origin of the coronaries while execution of the 16-channel multilayer scan made it possible to view their anomalous course and evidenced the interarterial course of the left coronary. The anomaly is described from the anatomo-functional point of view and diagnostic aspects are examined. The footballer was refused his fitness certificate and he will undergo twice-yearly follow-up with exercise testing. Surgery was not indicated because of the total asymptomaticity of the condition.