Fatal Coronary Artery Anomaly Concealed in Young Athletes with Exertional Syncope

Figure 1

(a) Transthoracic echocardiography (parasternal short axis) at initial examination. The origin of pain in the left coronary artery is not detected in its normal position. (b) Coronary computed tomography angiography (CCTA, three-dimensional reconstruction) depicting the left coronary artery originating from the right sinus of Valsalva. (c) CCTA shows that part of the left main coronary artery trunk runs between the aorta and pulmonary artery. (d) Measurements of the take-off angle from the ascending aorta in the left coronary artery. The solid line indicates the so-called ostium line, and the dashed line indicates the line drawn from the midpoint of the ostium line to a point along the center of the left main trunk. The angle between the two lines at the midpoint is measured as the take-off angle and is 22 degrees. Ao: aorta; PA: pulmonary artery; LCA: left coronary artery; RCA: right coronary artery; RCC: right coronary cusp; Left main coronary trunk.