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Fig. 13.3 A 22-year-old professional soccer player, female, asymptomatic. (a) Routine two-dimensional transthoracic echocardiography, as mandated by Italian rules for professional soccer players, shows a normal heart but (b) the presence of the right coronary ostium in the left sinus of Valsalva, with the anomalous tract coursing between aorta and pulmonary artery. (c) Coronary

CT-angiography (CTA) conrmed the diagnosis, showing an intra-adventitial course of the anomalous vessel. (d) CTA three-dimensional reconstruction of coronary arteries. (e, f) Despite this incidental nding, the cardiopulmonary exercise testing and stress electrocardiogram (not shown) were completely normal. RCA right coronary artery, LCA left coronary artery

Fig. 13.4 A Long-distance master runner, male, referred to our centre for exercise-induced left bundle branch block. (a) At the age of 47, two-dimensional transthoracic echocardiography (TTE) showed a unique ostium in the right sinus of Valsalva originating from both the right and the left coronary arteries. The left coronary artery (LCA)

had an interarterial/intramural course (TTE was executed in 1996 and this case was one of the rst three published in 1998, see ref. [24]). (b) Eight years later, at the age of 55, Coronary CT, which in the meantime became available in our hospital, conrmed the diagnosis, also showing atherosclerotic plaques in the LCA (dashed circle)

disqualifying them from sport, although we admit that Italian law, which attributes legal responsibility to sports physicians, partially inuences our behavior.

Anyhow, on the basis of our experience and literature data, we think that surgical treatment of AAORCA with interarterial/intramural course

should ever be considered in case of (a) symptoms during or immediately after exertion (Figs.13.1 and 13.2); (b) positive stress-tests for ischemia; (c) presence of an intramural proximal segment and/or critical reduction of lumen area (Figs.13.1,

13.2 and 13.3). In other cases, exercise restriction,

allowing however moderate recreational physical

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activity and a medical therapy (beta-blocking), seems safe enough even if beta- blocking therapy is not supported by evidence yet [18]. Nevertheless, in our series with conservative management and beta-blocking therapy (updated since our publication) [29], no athlete had recurrence of symptoms or major cardiac events during an average followup of 64months. However, for these subjects and for those who refuse surgery, more specic counseling concerning the risk of SCD is always mandatory and it should be undertaken with both the athlete and family.

When toAllow Coming Back toSport After SUGERY

Decision about returning to recreational highintensity or competitive sports after surgery requires careful evaluation. Different surgical techniques do not have the same results in removing potential mechanisms that might cause ischemia. Currently, the “unroong procedure” seems the most used and the more effective in most cases [63, 69, 73, 81–83], but it can have sequelae and it is not always feasible. Furthermore, in some cases, surgery can only partially resolve the problem [15]. To our knowledge, just a few cases of exercise SCD after surgery have been reported [15, 79], even if some authors have news of other pediatric deaths postoperatively, that have not been published [18]. It is interesting to note that, at least in the young, if a patient presents with resuscitated SCD and survives the surgery, he or she may still be at increased risk for an SCD when returning to sport [79].

Those who have undergone surgery will need close follow-up in the initial postoperative period: rst resting ECG and TTE at 7–10days from surgery, then at 4–6weeks with the rst functional test at 3months. If the rst controls give favorable results, after the rst year from intervention the interval between medical checks can be prolonged [18]. According to the recent North American guidelines, these patients may return even to competitive sports at least 3months postoperatively if an exercise stress test reveals no

evidence of myocardial ischemia or ventricular arrhythmias [18, 72, 84]. Regarding patients who experienced an aborted SCD, it is recommended that they do not return to competitive sport for at least 1 year postoperatively if they are fully asymptomatic and have a negative exercise stress test [18].

However, all these recommendations come from experts’ consensus papers, with a relatively low level of evidence [18, 72, 84]. Honestly speaking, we lack long-term follow-up of patients and athletes after surgical repair. Short- and medium-term results are encouraging; however, there are reports of issues, such as new aortic valve regurgitation that will need to be followed over time [18].

In our opinion, we can consider return to rec- reational high-intensity or competitive sport after surgery only if (a) surgery removed all mechanisms potentially responsible for exerciseinduced ischemia (Figs. 13.1 and 13.3); (b) no symptoms/signs of inducible myocardial ischemia and/or signicant arrhythmias or sequelae are present at least 6months after the procedure. For this purpose, we recommend an accurate “postsurgery protocol” including at least TTE, stress test ECG (we suggest a CPET), and CT/ MRI (preferably both) to evaluate the new anatomy and function of the operated coronary artery [15].

After return to competitive sport, we recommend ECG, TTE, and stress test follow-up every 6months for the rst 3years from surgery, with Holter monitoring when needed. After this period, the time interval may be prolonged to 1 year if no alterations have been encountered over time.

In all operated cases, however, we recommend that an automated external debrillator with trained personnel should be immediately available during competition and training, even if this should be the rule in modern sporting setting [85, 86].

Finally, those managed conservatively with exercise restriction will need follow-up annually [18, 87–89].

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References

1. Basso C, Maron BJ, Corrado D, Thiene G. Clinical prole of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35(6):1493–501.

2. Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007;115(10):1296–305.

3. Pérez-Pomares LM, de la Pompa JL, Franco D, Henderson D, Ho SY, Houyel L, Kelly RG, Sedmera D, Sheppard M, Sperling S, Thiene G, van den Hoff M, Basso C.Congenital coronary artery anomalies: a bridge from embryology to anatomy and pathophysiology—a position statement of the development, anatomy, and pathology ESC working group. Cardiovasc Res. 2016;109(2):204–16.

4. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126.595 patients undergoing coronary arteriography. Catheter Cardiovasc Diagn. 1990;21:28.

5. Yuksel S, Meric M, Soylu K, Gulel O, Zengin H, Demircan S, et al. The primary anomalies of coronary artery origin and course: a coronary angiographic analysis of 16,573 patients. Exp Clin Cardiol. 2013;18(2):121–3.

6. Angelini P, Velasco JA, Flamm S.Coronary anomalies: incidence, pathophysiology, and clinical relevance. Circulation. 2002;105:2449.

7. Angelini P, Cheong BY, Lenge De Rosen VV, Lopez A, Uribe C, Masso AH, Ali SW, Davis BR, Muthupillai R, Willerson JT. High-risk cardiovascular conditions in sports-related sudden death: prevalence in 5,169 schoolchildren screened via cardiac magnetic resonance. Tex Heart Inst J. 2018;45(4):205–13.

8. Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42(11):1959–63.

9. Angelini P.Novel imaging of coronary artery anomalies to assess their prevalence, the causes of clinical symptoms, and the risk of sudden cardiac death. Circ Cardiovasc Imaging. 2014;7:747–54.

10. Lo Rito M, Romarowski RM, Rosato A, Pica S, Secchi F, Giamberti A, Auricchio F, Frigiola A, Conti M. Anomalous aortic origin of coronary artery biomechanical modeling: toward clinical application. J Thorac Cardiovasc Surg. 2020;S0022-5223(20):32430–2.

11. Frescura C, Basso C, Thiene G, etal. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol. 1998;29(7):689–95.

12. Brothers JA, Whitehead KK, Keller MS, Fogel MA, Paridon SM, Weinberg PM, Harris MA.Cardiac MRI and CT: differentiation of normal ostium and intraseptal course from slitlike ostium and interarterial course

in anomalous left coronary artery in children. AJR Am J Roentgenol. 2015;204(1):W104–9.

13. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–

2006. Circulation. 2009;119(8):1085–92.

14. Brothers J, Gaynor JW, Paridon S, Lorber R, Jacobs M.Anomalous aortic origin of a coronary artery with an interarterial course: understanding current management strategies in children and young adults. Pediatr Cardiol. 2009;30(7):911–21.

15. Mery CM, Lawrence SM, Krishnamurthy R, et al. Anomalous aortic origin of a coronary artery: toward a standardized approach. Semin Thorac Cardiovasc Surg. 2014;26(2):110–22.

16. Jacobs ML. Anomalous aortic origin of a coronary artery: the gaps and the guidelines. J Thorac Cardiovasc Surg. 2017;153(6):1462–5.

17. Davis JA, Cecchin F, Jones TK, Portman MA.Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol. 2001;37(2):593–7.

18. Brothers JA, Frommelt MA, Jaquiss RDB, Myerburg RJ, Fraser CD Jr, Tweddell JS.Expert consensus guidelines: anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg. 2017;153(6):1440–57.

19. Duke C, Rosenthal E, Simpson JM. Myocardial infarction in infancy caused by compression of an anomalous left coronary artery arising from the right coronary artery. Cardiol Young. 2004;14:654–7.

20. Page HI, Engel HJ, Campbell WB, Thomas CS.Anomalous origin of the left circumex coronary artery. Recognition, angiographic demonstration and clinical signicance. Circulation. 1974;50:768–73.

21. West NE, McKenna CJ, Ormerod O, Forfar JC, Banning AP, Channon KM. Percutaneous coronary intervention with stent deployment in anomalouslyarising left circumex coronary arteries. Catheter Cardiovasc Interv. 2006;68(6):882–90.

22. Solberg EE, Borjesson M, Sharma S, Papadakis M, Wilhelm M, Drezner JA, et al. Sudden cardiac arrest in sports—need for uniform registration: a position paper from the sport cardiology section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Prev Cardiol. 2016;23:657–67.

23. Zeppilli P, Rubino P, Manno V, Cameli S, Palmieri V, Gorra A. Visualizzazione ecocardiograca delle arterie coronarie in atleti di resistenza. G Ital Cardiol. 1987;17:957–65.

24. Zeppilli P, dello Russo A, Santini C, Palmieri V, Natale L, Giordano A, Frustaci A. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest. 1998 Jul;114(1):89–93.

25. Frommelt PC, Frommelt MA, Tweddell JS, Jaquiss RD.Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol. 2003;42:148–54.

13 AAOCA in Young Athlete: How to Detect, What to Do, When to Allow Coming Back to Competitive…

https://t.me/medicina_free

183

26. Thankavel PP, Lemler MS, Ramaciotti C. Utility and importance of new echocardiographic screening methods in diagnosis of anomalous coronary origins in the pediatric population: assessment of quality improvement. Pediatr Cardiol. 2015;36:120–5.

27. Lee S, Uppu SC, Lytrivi ID, Sanz J, Weigand J, Geiger MK, etal. Utility of multimodality imaging in the morphologic characterization of anomalous aortic origin of a coronary artery. World J Pediatr Congenit Heart Surg. 2016;7:308–17.

28. Lorber R, Srivastava S, Wilder TJ, McIntyre S, De Campli WM, Williams WG, etal. Anomalous aortic origin of coronary arteries in the young: echocardiographic evaluation with surgical correlation. JACC Cardiovasc Imaging. 2015;8:1239–49.

29. Palmieri V, Gervasi S, Bianco M, Cogliani R, Poscolieri B, Cuccaro F, Marano R, Mazzari M, Basso C, Zeppilli P.Anomalous origin of coronary arteries from the "wrong" sinus in athletes: diagnosis and management strategies. Int J Cardiol. 2018;252:13–20.

30. Angelini P. Imaging approaches for Coronary artery anomalies: purpose and techniques. Curr Cardiol Rep. 2019;21(9):101.

31. Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for multimodality assessment of congenital Coronary anomalies: a guide from the American Society of Echocardiography: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2020;33(3):259–94.

32. Cantinotti M, Giordano R, Assanta N, Koestenberger M, Franchi E, Marchese P, Clemente A, Kutty S, D'Ascenzi F.Echocardiographic screening of anomalous origin of Coronary arteries in athletes with a focus on high take-off. Healthcare (Basel). 2021;9(2):231.

33. Brothers JA, Kim TS, Fogel MA, Whitehead KK, Morrison TM, Paridon SM, etal. Cardiac magnetic resonance imaging characterizes stenosis, perfusion, and brosis preoperatively and postoperatively in children with anomalous coronary arteries. J Thorac Cardiovasc Surg. 2016;152:205–10.

34. Marano R, Merlino B, Savino G, Natale L, Rovere G, Paciolla F, Muciaccia M, Flammia FC, Larici AR, Palmieri V, Zeppilli P, Manfredi R. Coronary computed tomography angiography in the clinical workow of athletes with anomalous origin of Coronary arteries from the contralateral Valsalva sinus. J Thorac Imaging. 2021;36(2):122–30.

35. Savino G, Piccolo FL, Merlino B, Rovere G, Bianco M, Gervasi SF, Palmieri V, Larici AR, Manfredi R, Marano R.Cardiac-CT with the newest CT scanners: an incoming screening tool for competitive athletes? Clin Imaging. 2021;78:74–92.

36. Hirono K, Hata Y, Miyao N, Nakaoka H, Saito K, Ibuki K, et al. Anomalous origin of the right coronary artery evaluated with multidetector computed

tomography and its clinical relevance. J Cardiol. 2016;68:196–201.

37. Roberts WO, Asplund CA, O’Connor FG, Stovitz SD.Cardiac preparticipation screening for the young athlete: why the routine use of ECG is not necessary. J Electrocardiol. 2015;48:311–5.

38. Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med. 2004;141:829–34.

39. Osaki M, McCrindle BW, Van Arsdell G, Dipch and aI. Anomalous origin of a coronary artery from the opposite sinus of Valsalva with an interarterial course: clinical prole and approach to management in the pediatric population. Pediatr Cardiol. 2008;29:24–30.

40. Angelini P, Monge J.Coronary artery anomalies. In: Morsucci M Goodman’s cardiac Catherization, angiography, and intervention. Riverwoods, IL: Lippincott Williams & Wilkins; 2013. p.325–53.

41. Angelini P, Monge JU, Forstall P, Ramirez JM, Uribe C, Hernandez E. Anomalous right coronary artery from the left sinus of Valsalva: pathophysiological mechanisms studied by intravascular ultrasound, clinical presentations and response to stent angioplasty. J Am Coll Cardiol. 2013;61:E1804.

42. Noel C.Cardiac stress MRI evaluation of anomalous aortic origin of a coronary artery. Congenit Heart Dis. 2017 Sep;12(5):627–9.

43. Uebleis C, Groebner M, von Ziegler F, Becker A, Rischpler C, Tegtmeyer R, Becker C, Lehner S, Haug AR, Cumming P, Bartenstein P, Franz WM, Hacker M. Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery. Int J Card Imaging. 2012;28(7):1763–74.

44. Strigl S, Beroukhim R, Valente AM, etal. Feasibility of dobutamine stress cardiovascular magnetic resonance imaging in children. J Magn Reson Imaging. 2009;29:313–9.

45. Nagel E, Lehmkuhl HB, Bocksch W, etal. Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation. 1999;99:763–70.

46. Prakash A, Powell AJ, Krishnamurthy R, Geva T.Magnetic resonance imaging evaluation of myocardial perfusion and viability in congenital and acquired pediatric heart disease. Am J Cardiol. 2004;93:657–61.

47. Buechel ER, Balmer C, Bauersfeld U, Kellenberger CJ, Schwitter J. Feasibility of perfusion cardiovascular magnetic resonance in paediatric patients. J Cardiovasc Magn Reson. 2009;11:51.

48. Scannell CM, Hasaneen H, Greil G, Hussain T, Razavi R, Lee J, Pushparajah K, Duong P, Chiribiri A. Automated quantitative stress perfusion cardiac magnetic resonance in pediatric patients. Front Pediatr. 2021;9:699497.

184

https://t.me/medicina_free

M. Bianco et al.

49. Doan TT, Molossi S, Sachdeva S, Wilkinson JC, Loar RW, Weigand JD, Schlingmann TR, Reaves-O'Neal DL, Pednekar AS, Masand P, Noel CV.Dobutamine stress cardiac MRI is safe and feasible in pediatric patients with anomalous aortic origin of a coronary artery (AAOCA). Int J Cardiol. 2021;334:42–8.

50. Kimball TR. Pediatric stress echocardiography. Pediatr Cardiol. 2002;23:347–57.

51. Lameijer H, Ter Maaten JM, Steggerda RC.Additive value of dobutamine stress echocardiography in patients with an anomalous origin of a coronary artery. Neth Hear J. 2015;23(2):139–40.

52. Glaab T, Taube C.Practical guide to cardiopulmonary exercise testing in adults. Respir Res. 2022;23(1):9.

53. Guazzi M, Adams V, Conraads V, Halle M, Mezzani A, Vanhees L, Arena R, Fletcher GF, Forman DE, Kitzman DW, Lavie CJ, Myers J, European Association, for Cardiovascular Prevention & Rehabilitation; American Heart Association. EACPR/ AHA scientic statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specic patient populations. Circulation. 2012;126(18):2261–74.

54. Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specic patient populations. Eur Heart J. 2018;39(14):1144–61.

55. Angelini P, Uribe C, Monge J, Tobis JM, Elayda MA, Willerson JT.Origin of the right coronary artery from the opposite sinus of Valsalva in adults: characterization by intravascular ultrasonography at baseline and after stent angioplasty. Catheter Cardiovasc Interv. 2015;86(2):199–208.

56. Boler AN, Hilliard AA, Gordon BM. Functional assessment of anomalous right coronary artery using fractional ow reserve: an innovative modality to guide patient management. Catheter Cardiovasc Interv. 2017;89(2):316–20.

57. Nørgaard BL, Leipsic J, Gaur S, etal. NXT trial study group, diagnostic performance of noninvasive fractional ow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (analysis of coronary blood ow using CT angiography: next steps). J Am Coll Cardiol. 2014;63(12):1145–55.

58. Sheng CC, Ghobrial J, Cho L.Patients with varying courses of single coronary artery: case series. Eur Heart J Case Rep. 2021;5(10):ytab314.

59. Cheitlin MD, De Castro CM, McAllister HA.Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva: a not-so-minor congenital anomaly. Circulation. 1974;50:780–7.

60. Taylor AJ, Byers JP, Cheitlin MD, Virmani R. Anomalous right or left coronary artery from the contralateral coronary sinus: “high-risk” abnormalities in the initial coronary artery course and heterogeneous clinical outcomes. Am Heart J. 1997;133:428–35.

61. Roberts WC, Siegel RJ, Zipes DP.Origin of the right coronary artery from the left sinus of Valsalva and its functional consequences: analysis of 10 necropsy patients. Am J Cardiol. 1982;49:863–8.

62. Elhmidi Y, Nöbauer C, Hörer J, Schreiber C, Lange R.Surgical unroong of an anomalous right coronary artery arising from the posterior left sinus of Valsalva. World J Pediatr Congenit Heart Sur. 2013;4(4):433–5.

63. Muñoz-Guijosa C, Permanyer E, Leta R.Anomalous origin of right coronary artery from the left coronary sinus: sudden death and successful surgical reimplantation. Eur Heart J. 2012;33(11):1308.

64. Kragel AH, Roberts WC.Anomalous origin of either the right or left main coronary artery from the aorta with subsequent coursing between aorta and pulmonary trunk: analysis of 32 necropsy cases. Am J Cardiol. 1988;62:771–7.

65. Meyer L, Stubbs B, Fahrenbruch C, Maeda C, Harmon K, Eisenberg M, et al. Incidence, causes, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults 0 to 35 years of age: a 30-year review. Circulation. 2012;126:1363–72.

66. Pilmer CM, Kirsh JA, Hildebrandt D, Krahn AD, Gow RM. Sudden cardiac death in children and adolescents between 1 and 19 years of age. Heart Rhythm. 2014;11:239–45.

67. Marijon E, Tafet M, Celermajer DS, Dumas F, Perier MC, Mustac H, etal. Sports-related sudden death in the general population. Circulation. 2011;124:672–81.

68. Cho SH, Joo HC, Yoo KJ, Youn YN.Anomalous origin of right coronary artery from left coronary sinus: surgical management and clinical result. Thorac Cardiovasc Surg. 2015;63:360–6.

69. Frommelt PC, Sheridan DC, Berger S, Frommelt MA, Tweddell JS.Ten-year experience with surgical unroong of anomalous aortic origin of a coronary artery from the opposite sinus with an interarterial course. J Thorac Cardiovasc Surg. 2011;142:1046–51.

70. Sharma V, Burkhart HM, Dearani JA, Suri RM, Daly RC, Park SJ, etal. Surgical unroong of anomalous aortic origin of a coronary artery: a single-center experience. Ann Thorac Surg. 2014;98:941–5.

71. Davies JE, Burkhart HM, Dearani JA, Suri RM, Phillips SD, Warnes CA, etal. Surgical management of anomalous aortic origin of a coronary artery. Ann Thorac Surg. 2009;88:844–7.

72. Van Hare GF, Ackerman MJ, Evangelista JA, Kovacs RJ, Myerburg RJ, Shafer KM, etal. Eligibility and disqualication recommendations for competitive athletes with cardiovascular abnormalities: task force 4: congenital heart disease: a scientic statement from the American Heart Association and American College of Cardiology. Circulation. 2015;132:e281–91.

73. Mainwaring RD, Murphy DJ, Rogers IS, etal. Surgical repair of 115 patients with anomalous aortic origin of a coronary artery from a single institution. World J Pediatr Congenit Heart Surg. 2016;7(3):353–9.

13 AAOCA in Young Athlete: How to Detect, What to Do, When to Allow Coming Back to Competitive…

https://t.me/medicina_free

185

74. Turner II, Turek JW, Jaggers J, Herlong JR, Lawson DS, Lodge AJ.Anomalous aortic origin of a coronary artery: preoperative diagnosis and surgical planning. World J Pediatr Congenit Heart Surg. 2011;2:340–5.

75. Mumtaz MA, Lorber RE, Arruda J, Pettersson GB, Mavroudis C.Surgery for anomalous aortic origin of the coronary artery. Ann Thorac Surg. 2011;91:811–4.

76. Erez E, Tam VK, Doublin NA, Stakes J.Anomalous coronary artery with aortic origin and course between the great arteries: improved diagnosis, anatomic ndings, and surgical treatment. Ann Thorac Surg. 2006;82:973–7.

77. Law T, Dunne B, Stamp N, Ho KM, Andrews D. Surgical results and outcome safter reimplantation for the management of anomalous aortic origin of the right coronary artery. Ann Thorac Surg. 2016;102:192–8.

78. Labombarda F, Coutance G, Pellissier A, etal. Major congenital coronary artery anomalies in a paediatric and adult population: a prospective echocardiographic study. Eur Heart J Cardiovasc Imaging. 2014;15(7):761–8.

79. Nguyen AL, Haas F, Evens J, Breur JM.Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an inter-arterial course: case report and review of the literature. Neth Hear J. 2012;20(11):463–71.

80. Gräni C, Buechel RR, Kaufmann PA, Kwong RY.Multimodality imaging in individuals with anomalous coronary arteries. JACC Cardiovasc Imaging. 2017;10(4):471–81.

81. Bria S, Chessa M, Abella R, etal. Aborted sudden death in a young football player due to anomalous origin of the left coronary artery: successful surgical correction. J Cardiovasc Med. 2008;9(8):834–8.

82. Wittlieb-Weber CA, Paridon SM, Gaynor JW, Spray TL, Weber DR, Brothers JA.Medium-term outcome after anomalous aortic origin of a coronary artery repair in a pediatric cohort. J Thorac Cardiovasc Surg. 2014;147(5):1580–6.

83. Romp RL, Herlong JR, Landolfo CK, etal. Outcome of unroong procedure for repair of anomalous aor-

tic origin of left or right coronary artery. Ann Thorac Surg. 2003;76(2):589–95.

84. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Developed in collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52:e143–263.

85. Link MS, Myerburg RJ, Estes NA III.Eligibility and disqualication recommendations for competitive athletes with cardiovascular abnormalities: task force 12: emergency action plans, resuscitation, cardiopulmonary resuscitation, and automated external debrillators: a scientic statement from the American Heart Association and American College of Cardiology. Circulation. 2015;132:e334–8.

86. Fukuda T, Ohashi-Fukuda N, Kobayashi H, Gunshin M, Sera T, Kondo Y, etal. Public access debrillation and outcomes after pediatric out-of-hospital cardiac arrest. Resuscitation. 2017;111:1–7.

87. Drezner JA, Rao AL, Heistand J, Bloomingdale MK, Harmon KG. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external debrillators. Circulation. 2009;120:518–25.

88. Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG.Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED use in sports. Br J Sports Med. 2013;47:1179–83.

89. Kitamura T, Kiyohara K, Sakai T, Matsuyama T, Hatakeyama T, Shimamoto T, et al. Public-access debrillation and out-of-hospital cardiac arrest in Japan. N Engl J Med. 2016;375:1649–59.

Sudden Death: Dierential

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Diagnosis andAOCA

BarbaraBarra andGherardoFinocchiaro

Introduction

Sudden cardiac death (SCD) is generally dened as the unexpected death of an individual not ascribed to an extracardiac cause, usually within 1h from the onset of symptoms in an apparently healthy subject [1] or if the deceased was known to be in good health 24h before death occurred [2]. Sudden cardiac death can be the rst manifestation of cardiac disease in apparently healthy individuals. Although considered to be relatively rare, it is a devastating event, causing a strong emotional and social impact within the community.

While atherosclerotic coronary artery disease is the predominant cause of SCD in older individuals (>35 years), in younger individuals (<35years of age), most deaths are attributed to

B. Barra Sports Medicine Unit, AULSS 2 Marca Trevigiana, Treviso, Italy e-mail: barbara.barra@aulss2.veneto.it

G. Finocchiaro (*) Cardiothoracic Centre, Guy’s and St Thomas’ Hospital, London, UK

King’s College London, London, UK

Royal Brompton and Hareeld Hospital, London, UK

Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George’s, University of London, London, UK e-mail: gherardo.nocchiaro@nhs.net

inherited or congenital, structural or electrical disorders of the heart, which predispose to malignant ventricular arrhythmias [3].

The true incidence of SCD is unknown and difcult to dene. SCD rates range from 40 to 100 per 100,000 in the general population [2], and it is a rare event in individuals of <35years old, with an incidence of 1 to 3 per 100,000 per year [4]. It is also well recognized that intensive exercise training and competitive sports participation are associated with a higher risk of adverse cardiovascular events, including SCD in predisposed individuals [5, 6]. One large prospective study by Corrado et al. systematically assessed the incidence of SCD in young athletes and reported it to be 2.3in 100,000 athletes per year, compared with 0.9 in 100,000 nonathletes per year [5].

More recent studies have reported a higher incidence than previously estimated in specic populations [7]. Male athletes, AfricanAmericans, and basketball players have been found to be at higher risk [8, 9]. Although recent studies have highlighted the high prevalence of cardiomyopathies and primary arrhythmia syndromes (which often present without structural cardiac abnormalities at postmortem examination) among cohorts of athletes who died suddenly [10–12], congenital coronary anomalies are among the most frequent causes of SCD in young and athletic individuals.

https://doi.org/10.1007/978-3-031-36966-7_14

187

188

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B. Barra and G. Finocchiaro

Anomalous origin of a coronary artery (AOCA) has been described as the second most frequent cause of SCD in young athletes in the United States, accounting for 17% of deaths [13] with other studies reporting a prevalence between 5% [11] and 11% [14].

AOCA andSCD

Most anomalies of the coronary origin do not manifest with any signicant cardiac symptom, do not have any hemodynamic implications, and are incidentally detected during diagnostic imaging or at autopsy. Although various AOCA phenotypes have been identied as normal or benign variants, a high risk of exercise-related sudden cardiac death has been reported in those with a

coronary artery arising from the pulmonary artery or from the opposite sinus of Valsalva with an interarterial course [15–17] (Fig. 14.1). Anomalous left coronary artery from pulmonary artery (ALCAPA) is extremely rare and usually presents in infancy, with clinical features of myocardial ischemia and/or congestive heart failure [19]. The anomalous right coronary artery arising from the left coronary cusp (ARCA) and the anomalous left coronary artery arising from the right coronary cusp (ALCA) with interarterial course appear to be the most common anatomical variants recognized at the postmortem examination in decedents of SCD [20] (Table14.1). When the anomalous coronary is interarterial, it may also run within the myocardial sulcus (intramyocardial) or within the anterior wall of the aorta (intramural) [21].

14 Sudden Death: Dierential Diagnosis andAOCA

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a b

189

Fig. 14.1 Origin of the Right Coronary from the Left Sinus of Valsalva. (a) Note the right coronary artery (RCA) arising from the left sinus of Valsalva. (b) Intramural course of the coronary artery within the aortic wall. (c, d) Computerized tomography scan showing

interarterial course of the right coronary artery arising from the left coronary sinus. LCA left coronary artery, LMS left main coronary artery. Modied from Finocchiaro etal. [ 18]

190

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Table 14.1 Autopsy studies of SCD in ARCA/ALCA patients

Total number Coronary-related SCD

ALCA

Author, year Cheitlin etal. (1974) 18 33 0/18 (0) 9/33

Kragel and Roberts (1988)

Taylor etal. (1992) 24 28 Not

Taylor etal., (1997) 21 9 4/21 (19) 8/9 (89) 83 66 Frescura etal.

(1998)

ALCA anomalous left coronary artery, ARCA anomalous right coronary artery, SCD sudden cardiac death. Adapted from Cheezum MK, Liberthson RR, Shah NR, etal. Anomalous Aortic Origin of a Coronary Artery From the Inappropriate Sinus of Valsalva. J Am Coll Cardiol. 2017;69 (12):1592–1608. doi:10.1016/j.jacc.2017.01.031

25 7 8/25 (32) 5/7 (71) Not reported 38

reported

7 4 4/7 (57) 4/4

(%)

(27)

23/28 (82)

(100)

% of deaths during exercise

78 Not reported

Not reported 66

75 50

B. Barra and G. Finocchiaro

% Asymptomatic before deathARCA ALCA ARCA (%)

Mechanisms ofSCD inAOCA

Slit-like/sh-mouth-shaped orice (more common in ARCA), acute angle take-off, intramural course, and interarterial course are the main anatomical patterns associated with exercise-related SCD involving AOCA [22].

In the presence of AOCA, SCD is supposed to be caused by lethal ventricular arrhythmias due to myocardial ischemia. Especially explosive bouts of exercise involve an increase in heart rate, blood pressure, cardiac output, and myocardial contractility, in order to increase the oxygen supply to the myocardium with an increased blood ow, which is compromised in the presence of AOCAs. The compression of coronary artery between the aorta and the pulmonary artery (interarterial course), the ostial obstruction of blood ow during exertion (slit-like orice and acute angle take-off), or proximal segment occlusion (intramural course in the aortic wall) are the postulated pathophysiologic mechanisms behind reversible ischemia and malignant arrhythmias [18]. Exercise-induced expansion of the aortic root and pulmonary artery could worsen the preexisting angulation of the coronary artery and thus reduce the diameter of the lumen in the proximal portion of the coronary artery. Finally, coronary arteries with anomalous origin can also have unstable hemodynamics, which cause blood

ow turbulence and injury to vascular endothelium and may lead to arteriosclerosis; moreover, an association with coronary spasm of proximal segment of the anomalous coronary artery with an interarterial course has been reported, as the compression or kinking phenomenon could result in some degree of intimal disruption and subsequent vasospasm [23].

Implications forCardiac Screening

The primary scope of pre-participation screening (PPS) with electrocardiography (ECG) is to identify a potentially life-threatening cardiac condition in apparently healthy individuals. Although PPS with ECG appears effective in detecting serious cardiac conditions such as cardiomyopathies and channelopathies, its value in identifying coronary artery anomalies is limited. In fact, the ECG is often normal and is not particularly useful in raising the suspicion of AOCA.Although the wide use of echocardiography in the setting of PPS is not supported by strong evidence, this test may be particularly helpful in the initial identication of AOCA, which can be conrmed by more advanced imaging techniques such as computerized tomoraphy angiography (CTA) or CMR.In a recent CMR-based population study by Angelini etal. [24], high-risk AOCAs were

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