Anomalous Origin of the Left Main Coronary Artery From the Right Sinus of Valsalva With an Intramural Course: A Rare Cause of Cardiac Arrest During Routine Patent Ductus Arteriosus Device Closure.

Congenital coronary artery anomalies (CCAAs) are rare. Usually, the myocardium derives its blood supply from the left and right main coronary arteries that arise from the left and right aortic sinuses of Valsalva respectively. However, in rare circumstances the left main coronary artery (LMCA) may have an anomalous origin from the right aortic sinus of Valsalva (RASV). The LMCA may take any of the following anomalous pathways: posterior to the aorta, anterior to the right ventricular outflow tract and between the aorta and the right ventricular outflow tract (RVOT). The anomalous course of the LMCA between the aorta and RVOT is sometimes called a "suicide coronary artery". It has been associated with sudden cardiac death during or just after vigorous exercise due to myocardial ischemia and development of ventricular arrhythmias. Although the first presentation of the anomaly is sometimes sudden cardiac death, in many of these patients there may be a history of syncope or prolonged chest pain before the fatal event. However, some patients are asymptomatic until the fatal event. This case highlights a rare occurrence of cardiac arrest in a six-year-old female undergoing routine patent ductus arteriosus (PDA) device closure. She was later diagnosed with a "suicide coronary" (anomalous left main coronary artery origin from the right aortic sinus of Valsalva).