Case Report
A 11 year-old male was referred to cardiology unit of our hospital from a general practitioner due to chest pain from last 10 days off and on not related to exertion not associated with sweating and non-radiating, there was no history of dyspnoea on effort, syncope, black out , palpitation at rest, and palpitation on activity. No family history of sudden death, angina or ischemic heart disease in family members. General and Physical examination was within normal limit. Laboratory examination showed normal value. Electrocardiogram at rest indicated sinus rhythm incomplete RBBB without sign of ischemia ( figure 1).
A non-invasive examination was performed with echocardiography. Transthoracic echocardiogram showed normal cardiac chamber dimension, normal right ventricle and left ventricle wall thickness, normal left and right ventricle systolic and diastolic function, and normal left ventricular segmental and global wall motion. Mitral valve and tricuspid valve were anatomically and functionally normal. Aortic valve examination showed three cusps with normal anatomy and function. Ostium and course of left coronary artery (LCA) was normal .Ostium of right coronary artery (RCA) was absent in normal position and coronary artery was arising anteriorly ( figure 2). There was no evidence of coronary artery compression. There no region wall motion abnormality.
ECG gated CT coronary angiography confirmed anomalous origin of the right coronary artery (RCA) with high take off from the sino tubular junction above the left coronary cusp and short interarterial course (1.5cm) between the ascending aorta and right ventricular outflow tract before reaching its usual position in the right atrio-ventricular groove. The origin was viewed in multiple views – there was no evidence of compression of the coronary artery, the origin of the vessel was circular in multiple views. The patient was diagnosed as abnormal right coronary from left sinus with inter-arterial course but with no evidence of compression. He was subjected to treadmill test , wherein he reached maximum predicted heart rate , without any evidence of ischemia or regional wall motion abnormality . No other structural cardiac abnormalities were found . Patient has been counselled to have regular follow up at 6 yearly interval. It is planned to subject him with stress test and thallium scan at regular intervals . He has been advocated to avoid competitive sports.