Angina, Anomalous Coronaries, Surgical Correction, and Return to Olympic Cycling

Anomalous aortic origin of a coronary artery (AAOCA) is an uncommon congenital abnormality associated with sudden cardiac death (SCD), particularly in young athletes.

We present a case of a 4-time Olympic medalist track cyclist who experienced sporadic anginal symptoms during maximal efforts and was found to have an anomalous aortic origin of the right coronary artery (AAORCA). The athlete had a successful surgical reimplantation and returned to elite sport.

Management decisions are complex: The investigations used to confirm ischemia and to stratify SCD risk are imperfect, and the surgical treatment carries potential risk. Furthermore, the impact of a sternotomy and coronary reimplantation on competitive sports performance has not been detailed.

In the absence of definitive ischemic evidence from history or diagnostic tests, diagnosing high-risk AAOCA can be challenging. The decision to pursue surgical intervention should carefully consider the low rate of SCD and the risk/impact of surgery.