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Single coronary artery giving rise to an intraseptal left coronary artery in a patient presenting with neurocardiogenic syncope.
MedLine Citation:
PMID:  21733341     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Syncope occurs frequently in adolescents, and is often benign. Potential worrisome syncopal events include those occurring with exertion, concurrent chest pain, dyspnoea or palpitations, and those with focal or diffuse neurologic changes.CaseA 16-year-old female was referred to our institution for a history of exercise-induced spells. She was diagnosed since the age of 2 years with neurocardiogenic syncope and postural orthostatic tachycardia syndrome. She had been evaluated at multiple institutions, and was followed by pediatric neurology for a diagnosis of migraines. Owing to recurrent worsening symptoms and a syncopal episode requiring resuscitation, an echocardiogram was performed. The right coronary was normal, but the left coronary artery ostium could not be identified well. Doppler patterns were suspicious of an abnormal left coronary artery, and computed tomography angiography was performed. This revealed a single coronary artery arising from the right aortic sinus, with the left coronary artery arising from the proximal coronary trunk and coursing through the infundibular septum. This was surgically treated utilising a left internal mammary artery bypass graft to the left anterior descending coronary artery. A year later, she has not experienced any recurrence of syncope, and has returned to athletic activity.ConclusionThis case highlights the index of suspicion that must be present when evaluating any patient with syncope, both clinically and via echocardiography. A computed tomography angiogram is indicated for better evaluation of coronary artery anatomy when an anomalous coronary cannot be ruled out by echocardiography.
Authors:
Jonathan N Johnson; Crystal R Bonnichsen; Paul R Julsrud; Harold M Burkhart; Donald J Hagler
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-23
Journal Detail:
Title:  Cardiology in the young     Volume:  -     ISSN:  1467-1107     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-7-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200019     Medline TA:  Cardiol Young     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-5     Citation Subset:  -    
Affiliation:
1Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic, College of Medicine, Rochester, Minnesota, United States of America.
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