An anomalous origin to a coronary artery may be missed by several diagnostic tests, but it can often be detected by transthoracic echocardiography.


Frequency: 0.08% (1 in 1,250)



(1)The anomalous artery arises from opposite aortic sinus from normal:

(1a) The left main coronary artery arises from right aortic sinus.

(1b) The right main coronary artery arises from left aortic sinus.

(2) The artery passes between the pulmonary artery and aorta (interartial course).


Clinical features in a young athlete:

(1) recurrent exertional chest pain

(2) syncope during exercise

(3) episodes of ventricular fibrillation, with an increased risk of sudden death

(4) ECG and exercise testing may be normal.


Doppler echocardiography can detect the anomalous origin if it is suspected and specifically looked for.


The diagnosis is confirmed by selective angiography.


Differential diagnosis:

(1) myocarditis

(2) cardiomyopathy

(3) long QT syndrome or other cardiac arrhythmia

(4) drug abuse

(5) aortic rupture


The condition can be cured by moving the affected to the artery to the correct aortic sinus.


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