Advice to Young Athletes With Anomalous Aortic Origin of a Coronary Artery With and Without Surgery
Silvana Molossi1, Shagun Sachdeva1
1Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas; The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Insights
Congenital coronary artery anomalies are a major cause of sudden cardiac death in youth. Evaluating myocardial perfusion under stress is key for risk stratification in these patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Congenital coronary artery anomalies are a significant cause of sudden cardiac death in young individuals.
- Anomalous aortic origin of a coronary artery is the most prevalent type, with left coronary artery anomalies posing a higher risk.
Purpose of the Study:
- To review current understanding and management strategies for congenital coronary artery anomalies.
- To highlight the importance of risk stratification and myocardial perfusion assessment in affected children and adolescents.
Main Methods:
- Review of existing literature on congenital coronary artery anomalies.
- Emphasis on diagnostic modalities, particularly stress-induced myocardial perfusion imaging.
- Discussion of clinical manifestations and risk factors.
Main Results:
- Anomalies of the left coronary artery are associated with increased risk of sudden cardiac arrest and myocardial ischemia.
- Anomalies of the right coronary artery are more common but generally less severe, though rare sudden events can occur.
- Myocardial perfusion assessment under provocative stress is crucial for evaluating young patients.
Conclusions:
- Risk stratification for congenital coronary artery anomalies requires further definition.
- Shared decision-making and counseling on exercise are vital for long-term management.
- Continued research is needed to clarify long-term outcomes.
Abstract:
Congenital coronary artery anomalies remain a leading cause of sudden cardiac death in the young. Within these, anomalous aortic origin of a coronary artery represents the largest group, with anomalies of the left coronary artery carrying higher risk for sudden cardiac arrest and clinical manifestations of myocardial ischemia. In contrast, anomalies of origin of the right coronary artery are more common and generally have a more benign clinical course, though rarely also associated with sudden events and myocardial ischemia. Risk stratification to guide management decisions remains to be well defined, though substantial advances have occurred in the last few years, with assessment of myocardial perfusion under provocative stress being an integral part of the evaluation in the young. Discussion and counseling on exercise behavior is essential to foster healthy lifestyle for these patients, acknowledging shared decision-making should be practiced in lieu of many unanswered questions as to outcomes long-term.
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