[A case of anomalous origin of right coronary artery from the left sinus of Valsalva with ventricular aneurysm ventricular tachycardia and paroxysmal A-V block].

A 51-year old man was admitted to our hospital, because of syncope. During admission, he had three episodes of syncopal attack. During the episodes, monitor ECG showed two times of ventricular tachycardia and one of paroxysmal A-V block. The left ventriculogram showed dilatation of left ventricle with posterobasal aneurysm, anterobasal and apical hypokinesis. The left coronary artery was normal. The right coronary artery originated from the left sinus of Valsalva and passed through between aortic root and pulmonary trunks. There was no atherosclerotic lesions in both coronary arteries. Non-sustained ventricular tachycardia was induced by triple premature stimulations. The inverse relation between the coupling interval of premature stimulation and the echo interval was recognized. Lidocaine (50 mg IV), Flecainide (300 mg/day), Mexiletine (450 mg/day), and Aprindine (60 mg/day) prevented ventricular tachycardia. Rapid atrial pacing induced paroxysmal A-V block. Permanent pacemaker was implanted because of syncope due to paroxysmal A-V block and ventricular tachycardia was prevented by Aprindine. Recently, the case with anomalous origin of the coronary artery increased by the popularity of coronary angiography. But, this case considered to be rare because of complication with ventricular aneurysm and lethal arrhythmia (ventricular tachycardia and paroxysmal A-V block).