Sudden death in pregnancy from congenital malformation of the coronary arteries.

We report the case of a 40 yr old previously healthy woman who died suddenly during her second pregnancy from unusual coronary artery anomalies. The left anterior descending coronary artery arose from the above of the right sinus of Valsalva 1.1 cm above the ridge in the aorta and coursed behind the pulmonary valve before it dipped deeply into the myocardium of the interventricular septum. The left circumflex coronary artery was hypoplastic. The right coronary artery arose also from above the right sinus of Valsalva 1.1 cm above the ridge in the aorta but was otherwise normal. A fourth small coronary artery arose between the origins of the left anterior descending and right coronary artery and supplied the outflow tract of the right ventricle. Mild fibrosis was present in the interventricular septum. The rest of the autopsy examination was unremarkable. Such combination of coronary artery anomalies causing sudden unexpected death in a pregnant woman have not previously been reported.