Unexpected sudden death resulting from anomalous origin of the right coronary artery from the left sinus of Valsalva: A case report involving identical twins

Abstract

An anomalous origin of the coronary arteries had been implicated as a cause of sudden cardiac death in a case involving a 16-year-old student who suddenly collapsed while running track at school. An autopsy revealed that the right coronary artery arose from the aorta in the left sinus of Valsalva. In order to determine whether the same anomaly was inherent in his brother – an identical twin – a complete cardiac medical examination was conducted. Multi-detector-row computed tomography (MDCT) coronary angiography showed no anomaly at the sinus of Valsalva, which indicates that the anomaly, in this case, was not hereditary. This case exemplifies instances where forensic medicine may intervene to prevent sudden deaths in surviving family members.

Introduction

Approximately 60–80 sudden deaths occur under school supervision in Japan, each year. Among these: 71% of them are sudden cardiac deaths [1]. Sudden cardiac deaths per 100,000 students occur at frequencies of 0.3 in elementary school students (6–12 years old); 0.8 in junior high school students (13–15 years old); and in 0.9 of high school students (16–18 years old) [1]. For adults, stenosis and occlusion of coronary arteries due to atherosclerosis are the main causes of ischemic heart attack and, in addition, an anomalous origin of the right or left coronary artery has been also implicated as a cause of sudden death [2]. However, the genesis of sudden death is still unknown. In this report, we illustrate and discuss an autopsy performed on a high school student with a right coronary artery originating from the left sinus of Valsalva.