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.