Exertional Syncope and a Congenital Cardiac Anomaly

We report on a 9-year-old healthy boy with a left main coronary artery arising from the right sinus of Valsalva coursing between the aorta and pulmonary artery who experienced a myocardial infarction after a syncopal episode during exercise. The high risk of sudden death associated with this anomaly during or immediately after vigorous activity makes immediate diagnosis and surgical intervention paramount. Diagnosis was made by transthoracic echocardiogram and confirmed by autopsy.