Vincenzo Palmieri1, Salvatore Gervasi1, Massimiliano Bianco1, Roberta Cogliani1, Barbara Poscolieri1, Francesco Cuccaro1, Riccardo Marano2, Mario Mazzari3, Cristina Basso4, Paolo Zeppilli5. 1. Sports Medicine Unit, Catholic University of the Sacred Heart, Rome, Italy. 2. Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy. 3. Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. 4. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padova, Italy. 5. Sports Medicine Unit, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: paolo.zeppilli@unicatt.it.
Abstract
AIMS: Although anomalous origin of left (AOLCA) and right coronary artery (AORCA) from the wrong sinus may cause sudden death (SD) in athletes, early diagnosis and management of these anomalies are still challenging. We analysed clinical/instrumental profiles of athletes identified with AOLCA/AORCA focusing our attention on diagnosis, management and follow-up. METHODS AND RESULTS: We report 23 athletes (17 males, mean age 27±17yrs.), 6 with AOLCA and 17 with AORCA. Diagnosis was made by trans-thoracic echocardiography (TTE) in 21/23(91%). Symptoms were present only in 10(41%). Only 3 had an abnormal rest-ECG and 9(39%) an abnormal stress test ECG (3 ST-depression, 4 ventricular arrhythmias, 1 supraventricular arrhythmias, 1 rate-dependent left-bundle-branch-block). Anatomy of the anomalous coronary artery showed no significant correlation with clinical presentation, except for a tendency to higher occurrence of proximal hypoplasia in symptomatic athletes (83% vs 40%, p=0.09). All athletes were disqualified from competitive-sports and advised to avoid strenuous effort. Surgery was recommended to all athletes with AOLCA and 6 with AORCA, but only 6 underwent surgery. No major cardiac events or ischemic symptoms/signs occurred during a mean follow-up of 65±70months. CONCLUSIONS: Early diagnosis of AOLCA/AORCA in athletes is feasible by TTE. Typical symptoms/signs of myocardial ischemia are present only in one third of cases thus underlying the need of a high index of clinical suspicion to achieve the diagnosis. After exercise restriction, none had major cardiac events or ischemia symptoms/signs recurrence. There was no correlation between anatomical characteristics and clinical presentation with the possible exception of coronary hypoplasia.
AIMS: Although anomalous origin of left (AOLCA) and right coronary artery (AORCA) from the wrong sinus may cause sudden death (SD) in athletes, early diagnosis and management of these anomalies are still challenging. We analysed clinical/instrumental profiles of athletes identified with AOLCA/AORCA focusing our attention on diagnosis, management and follow-up. METHODS AND RESULTS: We report 23 athletes (17 males, mean age 27±17yrs.), 6 with AOLCA and 17 with AORCA. Diagnosis was made by trans-thoracic echocardiography (TTE) in 21/23(91%). Symptoms were present only in 10(41%). Only 3 had an abnormal rest-ECG and 9(39%) an abnormal stress test ECG (3 ST-depression, 4 ventricular arrhythmias, 1 supraventricular arrhythmias, 1 rate-dependent left-bundle-branch-block). Anatomy of the anomalous coronary artery showed no significant correlation with clinical presentation, except for a tendency to higher occurrence of proximal hypoplasia in symptomatic athletes (83% vs 40%, p=0.09). All athletes were disqualified from competitive-sports and advised to avoid strenuous effort. Surgery was recommended to all athletes with AOLCA and 6 with AORCA, but only 6 underwent surgery. No major cardiac events or ischemic symptoms/signs occurred during a mean follow-up of 65±70months. CONCLUSIONS: Early diagnosis of AOLCA/AORCA in athletes is feasible by TTE. Typical symptoms/signs of myocardial ischemia are present only in one third of cases thus underlying the need of a high index of clinical suspicion to achieve the diagnosis. After exercise restriction, none had major cardiac events or ischemia symptoms/signs recurrence. There was no correlation between anatomical characteristics and clinical presentation with the possible exception of coronary hypoplasia.
Authors: Marius Reto Bigler; Afreed Ashraf; Christian Seiler; Fabien Praz; Yasushi Ueki; Stephan Windecker; Alexander Kadner; Lorenz Räber; Christoph Gräni Journal: Front Cardiovasc Med Date: 2021-01-21
Authors: Fleur M M Meijer; Anastasia D Egorova; Monique R M Jongbloed; Claire Koppel; Gracia Habib; Mark G Hazekamp; Hubert W Vliegen; Philippine Kies Journal: Interact Cardiovasc Thorac Surg Date: 2021-01-01
Authors: Fleur M M Meijer; Philippine Kiès; Diederick B H Verheijen; Hubert W Vliegen; Monique R M Jongbloed; Mark G Hazekamp; Hildo J Lamb; Anastasia D Egorova Journal: Front Cardiovasc Med Date: 2021-06-24