Monomorphic ventricular tachycardia as the first manifestation in a patient with anomalous coronary artery

• Autor(a) principal: Sousa, Júlio César Vieira de
• Data de Publicação: 2018
• Outros Autores: Miranda, Raiana Maciel, Madruga, Gabriela Melchuna, Farias, Domitila Costa de, Silva, Paula de Medeiros Nacácio e, Figueiredo, Nastassja Morgana de Sousa
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRN
• Texto Completo: https://repositorio.ufrn.br/handle/123456789/54321; https://doi.org/10.5935/2359-4802.20180057
• topic: arrhythmias; cardiac; tachycardia; ventricular; coronary vessel anomalies; death; sudden; cardiac

Coronary artery anomalies comprise a heterogeneous group of rare congenital heart defects, being classified according to their origin, course and distal bed, with an incidence ranging between 0.3% and 1.5% in the overall population. Dodge-Khatami et al.1 subdivided them into seven categories, according to their clinical complexity: coronary arteries originating from the pulmonary artery, coronary arteries with anomalous aortic origin, congenital atresia of the left main coronary artery, coronary arteriovenous fistulas, coronary arteries forming myocardial bridges, coronary artery aneurysms and coronary stenosis. The Texas Children's Hospital classification uses angiotomography with virtual angioscopy and divides the classification into three topics: origin of the anomalous coronary artery, coronary artery course and ostium morphology. From the viewpoint of anatomical risk, the anomalous left coronary artery with an interarterial course, presence of intramurality and a slit-like ostium are the main predictive factors of severity. A specific type is the anomalous origin of the left coronary artery from the right coronary sinus with an interarterial course, which is associated with hard outcomes in approximately 60% of the cases.2 Clinically, patients may present with nonspecific symptoms, ranging from palpitations, chest pain, post-exertion syncope or remain asymptomatic throughout life, with sudden death being the first and only manifestation of this condition. Most cases have been reported in young male individuals, but there is no scientific evidence yet whether the incidence is actually higher in males, or if this gender is more often diagnosed by performing more intense physical activities, therefore triggering symptoms. The most common of these conditions is the anomalous origin of the left coronary artery from the pulmonary artery. However, we present herein a case with an anomalous origin of the left coronary artery from the right coronary sinus, with a proximal course between the aortic and the pulmonary arteries in a 31-year-old man.