BACKGROUND: @entity1163 occurs frequently in adolescents, and is often benign. Potential worrisome @entity1163 events include those occurring with exertion, concurrent @entity662 , dyspnoea or palpitations, and those with focal or diffuse neurologic changes. CASE: A 16-year-old female was referred to our institution for a history of exercise-induced spells. She was diagnosed since the age of 2 years with @entity907 and postural @entity591 . She had been evaluated at multiple institutions, and was followed by pediatric neurology for a diagnosis of @entity2704 . Owing to recurrent @entity1109 and a @entity1163 requiring resuscitation, an echocardiogram was performed. The right coronary was normal, but the left coronary artery ostium could not be identified well. Doppler patterns were suspicious of an abnormal left coronary artery, and computed tomography angiography was performed. This revealed a single coronary artery arising from the right aortic sinus, with the left coronary artery arising from the proximal coronary trunk and coursing through the infundibular septum. This was surgically treated utilising a left internal mammary artery bypass graft to the left anterior descending coronary artery. A year later, she has not experienced any recurrence of @entity1163 , and has returned to athletic activity. CONCLUSION: This case highlights the index of suspicion that must be present when evaluating any @entity1 with @entity1163 , both clinically and via echocardiography. A computed tomography angiogram is indicated for better evaluation of coronary artery anatomy when an anomalous coronary cannot be ruled out by echocardiography.

Single coronary artery giving rise to an intraseptal left coronary artery in a @entity1 presenting with XXXX .

@entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain'] @entity1 :: ('9606', 'Species') :: ['patient'] @entity907 :: ('MESH:D019462', 'Disease') :: ['neurocardiogenic syncope'] @entity1109 :: ('MESH:D012678', 'Disease') :: ['worsening symptoms'] @entity1163 :: ('MESH:D013575', 'Disease') :: ['syncopal', 'syncope', 'Syncope', 'syncopal episode'] @entity591 :: ('MESH:D013610', 'Disease') :: ['orthostatic tachycardia syndrome'] @entity2704 :: ('MESH:D008881', 'Disease') :: ['migraines']
@entity907 :: (MESH:D019462,Disease) :: ['neurocardiogenic syncope']
