Objectives Congenital coronary artery anomalies (CAAs) have been incriminated as the second cause of sudden cardiac death (SCD) among young athletes, probably provoked by myocardial ischemia. In Greece, during the years 2010-2014 in Attica and Cyclades region, 134 SCD of young athletes were recorded and among them, 12 athletes (8.95%) were found with CAAs. Adolescent and young adults involved in sports activity have 2.8 greater risk of SCD than their non-athletic counterparts. The risk is multiplied in athletes with anomalous origin of coronary arteries (CAs). Single CAs, Bland-White-Garland syndrome, anomalous CAs arising from the opposite sinus of Valsalva (SV), having an interarterial course and CA fistulas have been classified as potentially “malignant CAAs”.
The aim of the study is to detect the incidence of CAAs in Greeks and distinguish whether the incidence of malignant CAAs is countable corresponding to a potential high risk of SCD in young athletes.
Methods Coronary arteriograms of 8157 patients (mean age 50.4 ± 20 years) during the years 2007-2012, from the 1st Department of Cardiology of Hippokration Hospital were retrospectively reviewed.
Results One hundred and forty-one patients (1.73%) had CCAs. Twenty-nine cases (0.36%) were characterised as “high risk” for SCD in patients undergoing coronary arteriography and 20.6% was the frequency among patients with CAAs. In 2 patients (0.025%), the left coronary artery (LCA) originated from the right SV and 12 patients (0.14%) had a RCA arising from the left SV with a malignant interarterial course that may also convey a risk for SCD after intensive sports activity. Only one LCA (0.012%) originated from pulmonary artery. Six cases (0.074%) of a single CA (0.025% originated from the right SV and 0.037% from the left SV. High take-off of the RCA was seen in 30 patients (0.37%), of the LCA in 2 patients (0.025%) of both CAs in 2 patients (0.025%). Separate origin of the left anterior descending artery (LAD) and left circumflex artery (LCx) from the left SV was found in 33 patients (0.4%). In 11 patients (0.13%) the RCA arose from a non-coronary sinus. In 17 patients (0.21%) an abnormal origin of LCx from the right SV was found with a further posterior course within the atrioventricular groove and in 5 patients (0.061%) the RCA originated from the proximal part of pulmonary artery. In 6 patients (0.074%) a common ostium of pulmonary artery and RCA was detected. One patient (0.012%) was found with a LAD originated from the right SV. Three patients (0.037%) had congenital absence of LCx (2 had a superdominant RCA). Coronary fistulas were found in 10 patients (0.12%) (8 between RCA and LCA and 2 between LCA and LCx).
Conclusions: Considering the large number of youthful participants in competitive athletic programs, appropriate measures of prevention and treatment are critical. The best available data indicate that the total number of SCD in athletes is relatively small and proven strategies to prevent these deaths are not currently available. Exact anatomic characterisation of CCAs is essential for identifying potentially malignant characteristics and guiding further work-up and treatment decisions. Knowing the anatomic variations of the heart vessels enhances the quality of treatment, especially when an angioplasty or a bypass is considered.
- coronary arteries anomalies
- sudden cardiac death
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