Multimodality cardiac imaging for diagnosing rare causes of cardiac arrest

Excerpt

An 18-year-old male was admitted after cardiac arrest (CA) while playing basketball. The initial rhythm was ventricular fibrillation. Immediate coronary angiography showed an aberrant but patent RCA. Left ventricular function was normal, without wall motion abnormalities. To avoid a delay in neuroprotective intensive care management, prolonged catheter manipulation to achieve selective intubation of the RCA was not enforced. Therapeutic hypothermia for 24 h was provided. The ECG and cardiac biomarkers were not suggestive for the cause of CA. The patient was weaned from mechanical ventilation on the third day with good neurologic results. Cardiac MRI showed a small inferior subendocardial myocardial infarction on delayed enhancement imaging (Fig. 1a, black arrows). T2-weighted imaging showed corresponding myocardial edema demonstrating that myocardial infarction was a recent event (Fig. 1b, white arrow). Cardiac CT revealed an aberrant RCA originating from the left sinus valsalva (Fig. 1c) with an interarterial course (Fig. 1d, black arrowhead), which is a well-recognized cause for CA in young athletes [1]. The patient underwent CABG using the right internal mammary artery (RIMA) as a single bypass to the RCA, which is an established method for treating this type of hazardous coronary anomaly [2]. By eliminating the cause, no ICD implantation was necessary.

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