Acquired and congenital coronary artery abnormalities

Area of Science:

• Cardiology
• Pediatric Cardiology
• Sports Cardiology

Background:

• Congenital and acquired coronary artery abnormalities are implicated in approximately 20% of sudden unexpected cardiac deaths in young athletes.
• Kawasaki disease is a primary cause of acquired coronary artery abnormalities, potentially leading to severe sequelae like aneurysms, stenosis, and thrombosis.
• Anomalous coronary artery origins, such as ALCAPA and those originating from the opposite sinus, can manifest as myocardial ischemia, arrhythmias, and sudden death, particularly with interarterial courses.

Purpose of the Study:

• To review the causes and clinical manifestations of coronary artery abnormalities in young athletes.
• To discuss the diagnostic and management strategies for various coronary artery anomalies.
• To highlight the current gaps in consensus regarding the management of specific asymptomatic coronary artery anomalies.

Main Methods:

• Review of literature on coronary artery abnormalities, Kawasaki disease, and sudden cardiac death in athletes.
• Analysis of clinical presentations, diagnostic findings, and treatment outcomes.
• Discussion of current guidelines and areas lacking consensus in management.

Main Results:

• Kawasaki disease and anomalous coronary artery origins are significant contributors to exercise-related sudden cardiac death in athletes.
• Anomalous left coronary artery from the pulmonary artery can present in adulthood with ischemic events despite initial collateralization.
• Anomalous coronary arteries with an interarterial course, especially originating from the opposite sinus, pose a high risk of sudden cardiac death during exercise.
• Myocardial bridging is generally benign but can rarely cause exercise-induced syndromes or cardiac death.

Conclusions:

• Symptomatic patients with coronary artery abnormalities require surgical correction.
• Asymptomatic patients with anomalous right coronary artery from the left sinus of Valsalva typically do not require treatment.
• Management of asymptomatic patients with anomalous left coronary artery from the right sinus of Valsalva and an interarterial course remains controversial.
• Further research is needed to establish clear management guidelines for all types of coronary artery anomalies in athletes.