Case Report http://dx.doi.org/10.3349/ymj.2011.52.5.856 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 52(5):856-858, 2011 Unexpected Sudden Death of a 19-Year-Old Female with Congenital Single Coronary Artery Ostium during Exertion You-Jin Won, Hee-Jin Kim, and Ho Lee Department of Forensic Medicine, Chonbuk National University Medical School, Jeonju, Korea. Received: April 17, 2010 Revised: May 18, 2010 Accepted: May 20, 2010 Corresponding author: Dr. Ho Lee, Department of Forensic Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju 561-180, Korea. Tel: 82-63-270-3064, Fax: 82-63-270-4598 E-mail: foremed@jbnu.ac.kr ∙ The authors have no financial conflicts of interest. Coronary artery anomalies are associated often with myocardial ischemia or sud- den cardiac death. A 19-year-old woman who participated in an exertive game lost consciousness upon one such exertion. She was taken to a hospital where she died on the same day. An autopsy revealed that she had bifurcated coronary arteries, which arose from one coronary ostium in the left sinus of Valsalva. The right coro- nary artery arose from the left sinus and traveled between the aorta and the pulmo- nary trunk. The heart as well as the cardiac conduction system depended exclu- sively on the single coronary artery ostium for oxygenated blood supply, and the unbalanced blood distribution on her exertion probably led to sudden cardiac death. The case highlights the medicolegal importance of unexpected sudden cardiac death related to an anomalous origin of the coronary arteries. Key Words: Exertion, sudden death, congenital single coronary artery INTRODUCTION A single coronary artery originating from the left or right coronary ostium occurs infrequently. Clinical outcomes for these anomalies are unfavorable. Congenital coronary artery anomalies are often detected incidentally by coronary angiography or autopsy findings. Unfortunately, these anomalies are not detectable on an elec- trocardiogram, chest X-ray, or thoracic echocardiography.1 The classification of coronary anomalies has been developed in accordance with the origin, course, and termination of the anomalous vessel. Certain anomalies are related to syncope, angina pectoris, exertional dyspnea, heart disease, and sudden death.2 Patients who have coronary anomalies could also have other cardiac mal- formations, however, may not be aware of this risk or the implications of those po- tential malformations. This report describes a young woman who unexpectedly died shortly after the onset of symptoms and was identified postmortem as an undiagnosed congenital coronary anomaly. CASE REPORT According to the police report, a 19-year-old woman who majored in Security Ser- © Copyright: Yonsei University College of Medicine 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 856 Yonsei Med J http://www.eymj.org Volume 52 Number 5 September 2011