Case Report: Syncope in an 11-year-old girl induced by anomalous aortic origin of the coronary artery, initially diagnosed via echocardiography.

Anomalous aortic origin of the coronary artery (AAOCA) is a relatively rare congenital coronary anomaly identified as a common cause of exercise-induced cardiac syncope and sudden death in young individuals. In most cases, the coronary artery courses between the aorta and pulmonary artery, exhibiting an intramural trajectory within the aortic wall. Herein, we present a case of an 11-year-old girl with AAOCA manifesting with sudden-onset syncope complicated by myocardial infarction as the initial symptom, along with a discussion of the underlying pathogenesis. This case is important as it highlights the fact that comprehensive coronary artery evaluation combined with high-quality imaging modalities is critical to enhance the diagnostic accuracy of coronary anomalies. As such, TTE should be established as an important first-line tool within a multimodality imaging pathway. for AAOCA.