Survival After Cardiac Arrest Due to an Anomalous Right Coronary Artery in a Young Athlete

Figures

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  Figure 1. Chest Radiograph and 12-Lead Electrocardiogram (A) Anteroposterior projection shows mild venocapillary congestion. (B) Electrocardiogram in sinus rhythm with a normal QT interval. A Brugada pattern was ruled out; unspecific flattened T waves in leads V1 and V2. Left anterior fascicular block. Criteria for left atrial enlargement were met: a notched P-wave in lead DII and a widened negative P-wave in lead V1.

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  Figure 2. Transesophageal Echocardiogram and Holter Monitoring (A) Midesophageal short-axis view shows anomalous origin of the right coronary artery from the left aortic sinus with an interarterial course; the fixed narrow coronary lumen strongly suggests an intramural segment. (B) 24-hour Holter monitoring registered 8% monomorphic premature ventricular contractions, in isolation and trigeminy.

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  Figure 3. Postoperative Coronary Computed Tomographic Angiography Double-oblique sagittal view and vessel short-axis views show a right coronary artery with a 9-mm unroofed segment (brackets). There is persistent angulation of <40° at the exit site and an interarterial course distal to the neo-ostium of 4 mm (arrow). Originally, coronary ostium was close to the intercoronary commissure and above the sinotubular junction, and nomenclature according to the Leiden convention and Texas Children's group was 2R∗, LCx and 2a-IV, respectively.

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  Figure 4. Rest Perfusion Cardiac Magnetic Resonance Short-axis images. Cine images in diastole (A) and systole (B) where generalized left ventricular hypokinesis was observed, predominantly at the interventricular septum and mild pericardial effusion. Rest left ventricular ejection fraction of 40%. (C) During first-pass perfusion at rest with normal myocardial enhancement. (D) Late gadolinium enhancement images show myocardium homogeneously hypointense, ruling out myocardial infarction.