You-Jin Won, et al. the left sinus of Valsalva. A coronary artery which origi- nates from the wrong aortic sinus may ultimately result in abnormal coronary circulation. Since the heart as well as the cardiac conduction system in the present case entirely de- pended on the single coronary artery for oxygenated blood supply, this can cause sudden cardiac death, which is often the first manifestation of the disorder. An anomalous coro- nary ostium originating from the wrong aortic sinus has a slit-like shape, which differs from a normal round coronary ostium. Because the contralateral coronary artery returns to its normal position, the aorto-coronary junction may form an acute angle, which can result in a slit-like ostium and a flap-like closure of the orifice. This occurrence can lead to bad flow in the beginning of the coronary stream.5 An anom- alous coronary artery that arises from the contralateral sinus may course between the aorta and the pulmonary trunk, an- terior to the pulmonary trunk and posterior to the aorta. The risk is due to coronary artery squeezing by virtue of the in- creased cardiac output during diastolic expansion of the vessels.6 Active exercise may increase the preexisting acute angulations of the coronary artery anomaly. In the present case, the deceased woman had the right coronary artery originating from the left sinus of Valsalva. The artery coursed between the pulmonary trunk and the aorta to the right of the atrioventricular groove. The cause of the woman’s death seems to be due to a relatively marked decrease of oxygenated blood through this abnormal coro- nary circulation, since it is highly likely that her unusual, abrupt physical and psychological excitation changed the blood flow pattern. Such an unbalanced blood circulation probably caused the dysfunction of the cardiac conduction system with the blood supply coming only from single cor- onary artery ostium, and this eventually led her to sudden cardiac arrest. The purpose of this report is to recommend the improve- ment of diagnosis and therapeutic management of coronary artery anomalies in young patients and to highlight their medicolegal importance in cases of sudden death. ACKNOWLEDGEMENTS This paper was supported by research funds of Chonbuk National University in 2010. REFERENCES 1. Zeina AR, Peres D, Barmeir E. Single coronary artery as cause of non-atheromatous angina pectoris: multidetector computed to- mography assessment. ISR Med Assoc J 2007;9:624-5. 2. Neil DA, Bonser RS, Townend JN. Coronary arteries from a sin- gle coronary ostium in the right coronary sinus: a previously unre- ported anatomy. Heart 2000;83:E9. 3. Taylor AJ, Virmani R. Coronary artery anomalies in adults: which are high risk? ACC Curr J Rev 2001;10:92-5. 4. Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 1998;29:689-95. 5. Basso C, Corrado D, Thiene G. Coronary artery anomalies and sudden death. Card Electrophysiol Rev 2002;6:107-11. 6. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of con- genital coronary artery anomalies with origin from the wrong aor- tic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35:1493-501. 858 Yonsei Med J http://www.eymj.org Volume 52 Number 5 September 2011