CONGRESS ABSTRACT

Competitive athlete for approximately ten years (endurance sports such as marathons, triathlon, swimming) without cardiac symptoms. Over the years, he has undergone serial Holter ECGs due to ventricular extrasystoles detected during visits. A year ago, during a routine check-up, he was referred for a cardiac MRI, which showed a thin stripe of intramural and epicardial fibrosis on the lateral wall and septum, initially compatible with post-inflammatory changes, with increased native T2 values in the septum, consistent with inflammatory activity. Several months later, the MRI was repeated with the following result: "normal biventricular size and function with signs of fibro-adipose infiltration of the left ventricle, doubtful coronary anomaly," which led to a recommendation for further investigation with coronary CT. The subsequent coronary CT revealed a coronary origin anomaly, with a single vessel originating from the right sinus of Valsalva, from which the left anterior descending artery originates. In the proximal segment, it has a long intramyocardial course as a septal branch. An eccentric calcified plaque in the left anterior descending artery was noted, but it did not cause hemodynamically significant stenosis (16%). After initiating beta-blocker therapy for approximately two weeks, an exercise test was performed, which was negative for arrhythmias and signs of ischemia. Only one ventricular ectopic beat at rest. The echocardiogram performed at our center showed normal dimensions, thicknesses, and biventricular contractility. No significant valvular abnormalities. No coronary ostium originating from the left sinus of Valsalva was visualized. The origin of the right coronary artery was normal, appearing at the upper limits of size (4-5 mm), and it follows the usual distribution territory, with an early branch consistent with the left anterior descending artery (the images do not clearly indicate an inter-arterial course but rather suggest a unique origin with an intra-septal course of the left anterior descending artery). In light of the clinical and instrumental history, the decision was made to proceed with coronary angiography and clinical follow-up, and sports activity was suspended.