DIAGNOSIS AND FOLLOW-UP OF ATHLETES WITH ANOMALOUS ORIGIN OF THE LEFT CIRCUMFLEX CORONARY ARTERY FROM THE RIGHT AORTIC SINUS
V. Pescatore1, C. Basso2, E. Brugin1, S. Compagno1, M. Vettori1, D. Noventa1, G. Thiene1, F. Giada1
1Cardiovascular Department, Sports Medicine Unit, P.F. Calvi Hospital, Noale-Venice, Italy. 2Department of Cardiac, Thoracic e Vascular Sciences, University of Padua, Padua, Italy
Background: Anomalous origin of coronary arteries (CA) is a cause of sudden death in the athletes. Origin of left circumflex (LCx) CA branch from the right aortic sinus or artery with a retro-aortic course, is the most frequent congenital CA anomaly. However, its clinical significance still remains unknown. The aim of the study was to assess the diagnostic value of transthoracic echocardiography (TTE) to diagnose this anomaly and to obtain follow-up data of these athletes.
Methods: During pre-participation screening, 11 asymptomatic athletes (aged 13-48 years) were identified with TTE suspicion of anomalous origin of LCx CA from right aortic sinus (“tubular shape” of the coronary running behind the aorta). The indications for TTE were: hypertension (1), systolic murmur (3), brady-arrhythmias (1), repolarization abnormalities (2), ST-T abnormalities during stress test (1), ventricular or supraventricular arrhythmias (3). To confirm the TTE suspicion, cardiac magnetic resonance (CMR) was performed in 8 and multidetector computed tomography in 3 athletes.
Results: The diagnosis of anomalous CA with a retro-aortic course was confirmed in 9/11 athletes (82%). In 8 athletes, all with anomalous origin of LCx CA from right aortic sinus and negative exercise stress test, no clinical events occurred during a mean follow-up of 24 months, despite they continued to participate in competitive sports activities. In the athlete with ST abnormalities during stress test and inducible ischemia at stress CMR with late enhancement, angiography demonstrated an anomalous origin of the right CA from the left aortic sinus running behind the aorta; this patient was disqualified from sport participation.
Conclusions: These data show a good specificity of TTE in detection of CA anomalies with a retro-aortic course. In the absence of signs of myocardial ischemia, short-term prognosis of athletes with this anomaly seems good. Further diagnostic work-up is mandatory for those athletes with ST-T abnormalities during stress test in order to exclude a major CA anomaly.
