Sudden death related to anomalous origin of coronary artery and coexisting fenestrated membrane of the sinus coronarius

Coronary artery anomalies that may be an isolated defect or part of complex congenital malformations of the heart are also often associated with a high risk of sudden death. A 19-year-old woman lost consciousness in the night. She was taken to hospital where she was treated. However, she died on the same day. The prosecutor considered the death suspicious, and the victim was taken to the morgue department for further examination and autopsy. On macroscopical examination, both coronary arteries originated from the left aortic sinus with the left one being dominant. The orifice of the sinus coronarius in the right atria was covered with a fenestrated membrane. Demonstration of coronary artery pathologies and associated anomalies in autopsies is vital for the elucidation of sudden death cases related to these lesions and for the development of new treatment approaches. The purposes of this case report are to characterise and identify markers of the coronary artery anomalies and to highlight their medicolegal importance in sudden death cases.