Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course

Abstract

Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised.

Anomalous aortic origin of a coronary artery: 90% of optimal therapy is 50% improved technology

“…Perhaps most disconcerting, some patients are developing more significant ischemia after surgery. [10][11][12] We need improved imaging and functional technology to bring clarity to the nature and anatomic causes of ischemia, as well as proof of its remedy. Perhaps technology such as intravascular ultrasound 4 and catheter-based fractional flow reserve 13 can be made suitable for use in children.…”

Anomalous Aortic Origin of a Coronary Artery: Toward a Standardized Approach

“…So far, to our knowledge, there has been only 1 report of SCD after surgical intervention for AAOCA. 41 This report from the Netherlands describes a 15-year-old high-school athlete who collapsed in the field and was found to have a myocardial infarction secondary to ALCA. At the time of surgical intervention, a slitlike orifice and intramural and interarterial courses were found.…”

Frequency of Coronary Artery Anomalies in patients undergoing Coronary Angiography.

“…2 These anomalies are the second most common cause of SCD in athletes, occurring between 12.2% and 17.2% in Western countries. [3][4][5] In a study which was conducted in Peshawar, Pakistan, the coronary anomalies were seen in 2.2% of study population. In this study the commonest anomalies were myocardial bridging, separate origins of LAD and LCX from aorta and LCX artery arising from right side of aorta.…”