IJCS | Volume 31, Nº5, September / October 2018

554 Figure 2 - A, B, C - Images showing the left coronary artery anomalous origin, from the right coronary artery. D - Coronary angiotomography showing the left coronary artery interarterial course. Sousa et al. Ventricular tachycardia and anomalous coronary Int J Cardiovasc Sci. 2018;31(5)551-555 Case Report opposite Valsalva sinus) had symptoms before the event, including syncope, chest pain and palpitations. All cases had an acute-angled outflow and a slit-like ostium. 8 Due to the varied and nonspecific symptomatology, clinical suspicion and detailed investigation are necessary. Thus, a 12-lead electrocardiogram, exercise testing and an echocardiogram are suggested for the initial approach of symptomatic patients, which in some cases may suggest the diagnosis or disclose another cause for the symptoms. Subsequently, a coronary angiotomography and a coronary angiography should be performed for diagnostic confirmation. 7 In cases of symptomatic patients, surgical revascularization is the therapeutic indication, especially when the left coronary artery originates from the opposite coronary sinus and courses between the aorta and the pulmonary artery, due to the risk of coronary compression by the larger-caliber vessels. 4,9 There is no consensus regarding the treatment of the anomalous anatomy with no evidence of ischemia or with an intramural course