Aberrant commissural positioning, hooding, and thrombotic occlusion of right and left coronary ostia in the left sinus of valsalva associated with small coronary arteries: a newly described anomaly and a cause of sudden death in an adolescent.

Reported is a triad of coronary artery anomalies associated with sudden and unexpected death in an adolescent occurring 10 hours after elective surgery. The abnormalities consisted of (1) the anomalous origins of both left and right coronary orifices in the left sinus of Valsalva, behind and through the commissure; (2) formation of a triangular septum between the upper portion of the commissure and the aorta, delineating a cul-de-sac which partially surrounded the coronary ostia; (3) small proximal coronary arteries. Development of a thrombus, putatively elicited by turbulence in the cul-de-sac, acted as a flutter valve to occlude both coronary ostia causing extensive acute myocardial infarction.