ABERRANT COMMISSURAL POSITIONING, HOODING, AND THROMBOTIC OCCLUSION OF RIGHT AND LEFT CORONARY OSTIA IN THE LEFT SINUS OF VALSALVA ASSOCIATED WITH SMALL CORONARY-ARTERIES - A NEWLY DESCRIBED ANOMALY AND A CAUSE OF SUDDEN-DEATH IN AN ADOLESCENT

Reported is a triad of coronary artery anomalies associated with sudde n and unexpected death in an adolescent occurring 10 hours after elect ive surgery. The abnormalities consisted of (1) the anomalous origins of both left and right coronary orifices in the left sinus of Valsalva , behind and through the commissure; (2) formation of a triangular sep tum between the upper portion of the commissure and the aorta, delinea ting a cul-de-sac which partially surrounded the coronary ostia; (3) s mall proximal coronary arteries. Development of a thrombus, putatively elicited by turbulence in the cul-de-sac, acted as a flutter valve to occlude both coronary ostia causing extensive acute myocardial infarc tion. Copyright (C) 1997 by W.B. Saunders Company.