Case reports Case 1 This 15 year old boy was a talented, competitive soccer player with a history of recurrent syncope during soccer training at the age of 6, 7, and 11. Previous investigations—including 12 lead electrocardiography, treadmill exercise testing, echocardiography, and electroencephalography—were normal. During a soccer game when he was 15, he had syncope and had to be resuscitated owing to ventricular fibrillation. On admission to our hospital he was in stable sinus rhythm, and arrhythmia did not recur. We diagnosed anomalous origin of the left coronary artery from the right aortic sinus from transthoracic echocardiography (fig 1 and fig 2). Colour Doppler transthoracic echocardiography showed the anomalous origin as well as the interarterial course of the left coronary artery (fig 2). The diagnosis was confirmed with selective angiography. The patient recovered from mild hypoxic cerebral damage, and after 13 months of neurological rehabilitation he had elective surgery: the aortic orifice of the left coronary was excised and reimplanted into the left coronary sinus. View larger version: In this window In a new window Fig 2 Echocardiography results for case 1. Top: Transthoracic echocardiography (parasternal short axis) showing the left coronary artery (double arrow) originating from the right aortic sinus (1) rather than from the left (2), with normal origin of the right coronary artery from the right aortic sinus (single arrow). Centre: Colour Doppler sonography showing the interarterial course of the left coronary artery (arrow) between aortic root and pulmonary artery (PA). Bottom: A slight inferior tilt of the transducer showing division of the left coronary artery (arrow) into left anterior and left circumflex branch Case 2 This 14 year old boy had had dyspnoea during school sports lessons when he was 12; he had had a treadmill exercise test, which was normal. One year later he had syncope while snowboarding, but this did not prompt further evaluation. At the age of 14 he felt exhausted during a soccer training session, developing syncope. He was resuscitated before an emergency team arrived and diagnosed ventricular fibrillation. Resuscitation was successful after administration of 12 DC shocks. On admission to our hospital he was in stable sinus rhythm, and electrocardiography showed no signs of acute myocardial ischaemia. Echocardiographic examination showed anomalous origin of the left anterior descending artery from the right aortic sinus. Colour Doppler transthoracic echocardiography showed the anomalous origin and the interarterial course of the left anterior descending artery. The diagnosis was confirmed with selective coronary angiography. During electrophysiological study ventricular tachycardia could not be induced by programmed stimulation. As a result of the hypoxia during the acute event, the patient developed spastic quadriplegia. After 12 months of neurological rehabilitation he underwent surgical correction with excision and reimplantation of the aortic orifice of the left anterior descending artery to the left coronary sinus.