Pre-Participation Echocardiographic Clue to Anomalous Aortic Origin of the Left Anterior Descending Artery in an Endurance Athlete

Anomalous aortic origin of a coronary artery may remain undetected during standard pre-participation cardiovascular screening. We report a 45-year-old asymptomatic marathon runner with normal physical examination and electrocardiogram. Transthoracic echocardiography showed a retroaortic tubular vascular structure with color flow, prompting coronary computed tomography angiography. Imaging demonstrated anomalous origin of the left anterior descending artery from the right sinus of Valsalva with an interarterial course and a coexisting retroaortic left circumflex artery. Functional and rhythm testing were reassuring. This case illustrates the potential incremental diagnostic value of echocardiography in selected athlete evaluations.