Which congenital coronary artery anomalies can cause sudden death?
Normally, the right and left main coronary arteries arise from the aorta at the right and left sinuses of Valsalva, respectively. Anomalous origin of the coronary arteries occurs rarely (seen in about 1% of cardiac catheterizations).
Sudden death is associated with the left main coronary artery arising from the right sinus (particularly when the artery courses between the aorta and the pulmonary artery, known as an interarterial course), the RCA arising from the left sinus with an interarterial course, or a single coronary artery.
The left main coronary artery may also arise from the pulmonary trunk; this anomaly tends to manifest earlier, with congestive heart failure or sudden death.