A case of anomalous origin of the right coronary artery from the left sinus of Valsalva exhibiting the Wolff-Parkinson-White syndrome

A 56-year-old male with the Wolff-Parkinson-White syndrome wassuspected of having suffered a myocardial infarction followingattacks of chest pain. Serial measurements of serum creatinephosphokinase and the electrocardiographic findings after ajmalineloading virtually excluded the possibility of myocardial infarction.Paroxysmal tachycardia was not noted on 24 Holler electrocardiographicmonitoring. Both the left and right coronary arteries were foundby selective coronary angiography to originate from the leftsinus of Valsalva, but neither of the arteries showed organicstenoses. However, myocardial²⁰¹ Tl scintigraphy after exerciseindicated poor uptake in the high anterolateral wall, and atthe apex and septum near the anterior wall, which suggestedthe absence ofischaemia in the area supplied by the right coronaryartery. We speculate that a left coronary artery steal phenomenonwas the cause of the ischaemia after exercise in this patient.