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Junger Sportler mit rezidivierenden thorakalen Schmerzen und Synkopen während sportlicher Belastung

Young athlete with recurrent chest pain and syncope during athletic exertion

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Zusammenfassung

Ein 22-jähriger Patient, der seit seiner Jugend über belastungsinduzierte thorakale Schmerzen und Synkopen während sportlicher Aktivität klagt, wird zur weiteren Diagnostik und Therapie übernommen. Eine auswärtig durchgeführte Koronarangiographie zeigt einen anomalen Abgang der rechten Koronararterie (RCA) aus dem linken Sinus Valsalva (ACAOS). Zur Einschätzung der Prognose des Patienten wird eine computertomographische Angiographie (CTA) der Koronarien durchgeführt. Diese zeigt einen intramuralen, interarteriellen Verlauf des proximalen RCA-Segmentes zwischen Aorta und Truncus pulmonalis. Zusätzlich wird eine Dobutamin-Stress-MRT durchgeführt, die eine Wandbewegungsstörung der inferoseptalen Wand zeigt. Damit ist nicht nur der potenziell maligne Verlauf der Koronaranomalie, sondern auch ihre hämodynamische Wirksamkeit belegt. Der Patient wurde schließlich operativ mit einem Neoostium der RCA versorgt und ist seitdem beschwerdefrei. Der Fall zeigt den Stellenwert des kombinierten Einsatzes von CTA und MRT zur prognostischen Evaluation von Koronaranomalien.

Abstract

A 22-year-old Caucasian man was referred for further evaluation of exercise-induced angina and syncope. Coronary angiography showed an anomalous origin of the right coronary artery (RCA) from the left coronary sinus (ACAOS). To determine the prognostic value of this anomaly, we also performed a computed tomography angiography of the coronaries (coronary CTA), which showed an intramural, interarterial course of the proximal RCA segment between the aortic and pulmonary root. During dobutamine stress cardiac magnetic resonance imaging (CMR), we documented a stress-induced hypokinesia of the inferoseptal wall, which confirms the potential malignancy of the interarterial course. The patient underwent cardiac surgery to create a neoostium of the RCA and has been free of symptoms since then. This case illustrates the excellent prognostic value of the combined coronary CTA/dobutamine stress CMR approach to coronary anomalies.

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  1. Abteilung Kardiologie – Kardiale Bildgebung, Kerckhoff Klinik Bad Nauheim, Benekestraße 2–8, 61231, Bad Nauheim, Deutschland

    A. Rolf & T. Dill

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  1. A. Rolf
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  2. T. Dill
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Correspondence to A. Rolf.

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Rolf, A., Dill, T. Junger Sportler mit rezidivierenden thorakalen Schmerzen und Synkopen während sportlicher Belastung. Kardiologe 2, 506–512 (2008). https://doi.org/10.1007/s12181-008-0127-4

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