A New Clinical Sign of Anomalous Coronary Artery

¹ Departments of Pediatrics and Surgery, Sutter Hospitals and the Sutter Hospitals Medical Research Foundation, Sacramento, California

A three-year-old boy with an anomalous left coronary artery is reported. His only physical sign of cardiovascular disease was a grade 2/6 high frequency late apical systolic murmur. This murmur was probably due to mild mitral regurgitation associated with anterior papillary muscle insufficiecy. This sign of mitral regurgitation in patients with anomalous coronary artery has not previously been reported; however, holosystolic murmurs from moderate to marked mitral regurgitation have been observed frequently. It is postulated that a low intensity late apical systolic murmur may occur in some patients with anomalous coronary artery as an early sign of potentially progressive associated mitral valve dysfunction.