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Single coronary artery giving rise to an intraseptal left coronary artery in a patient presenting with neurocardiogenic syncope

Published online by Cambridge University Press:  23 May 2011

Jonathan N. Johnson ,
Crystal R. Bonnichsen ,
Paul R. Julsrud ,
Harold M. Burkhart  and
Donald J. Hagler
Jonathan N. Johnson
Affiliation:
Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic, College of Medicine, Rochester, Minnesota, United States of America
Crystal R. Bonnichsen
Affiliation:
Department of Medicine/Division of Cardiovascular Diseases, Mayo Clinic, College of Medicine, Rochester, Minnesota, United States of America
Paul R. Julsrud
Affiliation:
Department of Radiology, Mayo Clinic, College of Medicine, Rochester, Minnesota, United States of America
Harold M. Burkhart
Affiliation:
Department of Surgery/Division of Cardiothoracic Surgery, Mayo Clinic, College of Medicine, Rochester, Minnesota, United States of America
Donald J. Hagler*
Affiliation:
Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic, College of Medicine, Rochester, Minnesota, United States of America
*
Correspondence to: Dr D. J. Hagler, MD, Department of Surgery/Division of Cardiothoracic Surgery, Mayo Clinic, MB 4-506, 200 First Street SW, Rochester, Minnesota 55905, United States of America. Tel: 507 266 0676; Fax: 507 284 3968; E-mail: [email protected]
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Abstract

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.

Case

A 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.

Conclusion

This 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.

Keywords

Syncopeanomalous coronary arterysingle coronary arteryneurocardiogenic syncope
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 5 , 09 September 2011 , pp. 572 - 576
Copyright
Copyright © Cambridge University Press 2011

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