Author + information
- Received September 21, 2012
- Revision received October 3, 2012
- Accepted October 9, 2012
- Published online April 23, 2013.
A totally asymptomatic 40-year-old man requested a medical certificate for marathon running. He had no cardiovascular risk factors, no history of chest trauma. There was a moderate diastolic heart murmur. Arterial pressure and electrocardiography were normal. Echocardiography showed moderate aortic insufficiency, without left ventricular (LV) abnormality. Exercise treadmill test (270 W) revealed 1.4-mm ST-segment depression (ascending), without chest pain. Multislice computed tomography (A) and coronary angiogram (B, Online Video 1) showed a tricuspid aortic valve, but the left anterior semilunar cusp (open arrow), of normal size, was completely isolated from the rest of the aorta (Ao), continuous with the aortic wall. The left coronary artery (LCA) was fed by right ventricular (RV) branches (solid arrows) and posterolateral (PL) branch of the right coronary artery (RCA). Single-photon emission computed tomography (C) demonstrated mild, partially reversible apical hypoperfusion. Magnetic resonance imaging (D) showed very limited delayed hyperenhancement of the apical myocardium. Beta-blockers were recommended in this asymptomatic and athletic young patient; no medical certificate for running (the initial reason for consultation), however, was renewed. Circ = circumflex coronary artery; LAD = left anterior descending; LAO = left anterior oblique; RAO = right anterior oblique artery.
- Received September 21, 2012.
- Revision received October 3, 2012.
- Accepted October 9, 2012.
- American College of Cardiology Foundation