Anomalous Coronary Artery and SIDS

In reading your recent post regarding death in children over one year old, you mentioned anomalous coronary artery. Last week, we finally (after 8 1/2 months) got to see our daughter's autopsy report, and her cause of death was listed as anomalous coronary artery. Our pediatrician copied several articles for us regarding other infants who died of this anomaly. One article, published in 1994, said that there were only 6 known cases of this particular anomaly (anomalous origin of the right coronary artery from the left sinus of valsalva).

Hi... to my knowledge, this is still the case. This is a very rare condition and my articles on it don't report this particular version of ACA (anomalous coronary artery) after 1994. Anomalous origin of the left coronary artery from the pulmonary artery is much more common (although still rare). You're correct, of course, that it is very difficult to diagnose in infancy. In adults they may have chest pain with exertion but this would be difficult to detect in an infant. Sometimes an infant will suddenly go into heart failure and, in some cases, it can be 'caught' before it actually causes death. Unfortunately, however, in other cases the first sign of it is fatal.

Do you have any experience with infant deaths due to anomalous coronary artery? The articles we read suggested that perhaps some SIDS deaths could be attributed to this anomaly.

I don't have personal experience with this diagnosis. It is my understanding that pathologists look for this abnormality when doing a thorough post-morterm examination.

If you do know of any of these deaths in infants, do you have any more recent information than 1994? I'm curious as to how many more infant deaths have been attributed to anomalous coronary artery since then.

I don't have any more information on this particular abnormality since that 1994 Italian article was published. There have been others on anomalous *left* coronary artery. Perhaps someone else out there has more information.

Best regards,
John L. Carroll, M.D.
The Johns Hopkins Children's Center
Baltimore, MD