Skip to main content Accessibility help
×
Home
Hostname: page-component-684899dbb8-gblv7 Total loading time: 0.193 Render date: 2022-05-18T01:41:39.845Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }

Acquired and congenital coronary artery abnormalities

Published online by Cambridge University Press:  13 January 2017

Ming-Lon Young*
Affiliation:
Heart Institute, Joe DiMaggio Children’s Hospital, Hollywood, Florida, United States of America
Michael McLeary
Affiliation:
Department of Radiology, Joe DiMaggio Children’s Hospital, Hollywood, Florida, United States of America
Kak-Chen Chan
Affiliation:
Heart Institute, Joe DiMaggio Children’s Hospital, Hollywood, Florida, United States of America
*
Correspondence to: M.-L. Young, MD, 1150 North 35 Ave, Suite 575, Hollywood, FL 33021, United States of America. Tel: 954 265 3437; Fax: 954 967 7619; E-mail: mingyoung@mhs.net

Abstract

Sudden unexpected cardiac deaths in approximately 20% of young athletes are due to acquired or congenital coronary artery abnormalities. Kawasaki disease is the leading cause for acquired coronary artery abnormalities, which can cause late coronary artery sequelae including aneurysms, stenosis, and thrombosis, leading to myocardial ischaemia and ventricular fibrillation. Patients with anomalous left coronary artery from the pulmonary artery can develop adequate collateral circulation from the right coronary artery in the newborn period, which remains asymptomatic only to manifest in adulthood with myocardial ischaemia, ventricular arrhythmias, and sudden death. Anomalous origin of coronary artery from the opposite sinus occurs in 0.7% of the young general population aged between 11 and 15 years. If the anomalous coronary artery courses between the pulmonary artery and the aorta, sudden cardiac death may occur during or shortly after vigorous exercise, especially in patients where the anomalous left coronary artery originates from the right sinus of Valsalva. Symptomatic patients with evidence of ischaemia should have surgical correction. No treatment is needed for asymptomatic patients with an anomalous right coronary artery from the left sinus of Valsalva. At present, there is no consensus regarding how to manage asymptomatic patients with anomalous left coronary artery from the right sinus of Valsalva and interarterial course. Myocardial bridging is commonly observed in cardiac catheterisation and it rarely causes exercise-induced coronary syndrome or cardiac death. In symptomatic patients, refractory or β-blocker treatment and surgical un-bridging may be considered.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Maron, BJ, Thompson, PD, Ackerman, MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Circulation 2007; 115: 16431655.CrossRefGoogle ScholarPubMed
2. Wu, MH, Burns, JC, Rowley, AH, et al. State-of-the-art basic and clinical science of Kawasaki disease. Pediatr Health 2008; 2: 405409.CrossRefGoogle Scholar
3. Chang, FY, Hwang, B, Chen, SJ, Lee, PC, Meng, CC, Lu, JH. Characteristics of Kawasaki disease in infants younger than 6 months of age. Pediatr Infect Dis J 2006; 25: 241244.CrossRefGoogle Scholar
4. Newburger, JW, Takahashi, M, Gerber, MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110: 27472771.CrossRefGoogle Scholar
5. Halliday, B, Murgatroyd, F, Whitaker, D, Dworakowski, R. Sudden cardiac arrest in adolescence: the case of ventricular fibrillation 11 years after presenting with Kawasaki’s disease. Heart 2012; 98: 1756.CrossRefGoogle ScholarPubMed
6. Kato, H, Ichinose, E, Kawasaki, T. Myocardial infarction in Kawasaki disease: clinical analyses in195 cases. J Pediatr 1986; 108: 923927.CrossRefGoogle ScholarPubMed
7. Tsuda, E, Matsuo, M, Naito, H, Noguchi, T, Nonogi, H, Echigo, S. Clinical features in adults with coronary arterial lesions caused by presumed Kawasaki disease. Cardiol Young 2007; 17: 8489.CrossRefGoogle ScholarPubMed
8. JCS Joint Working Group. Guidelines for diagnosis and management of cardiovascular sequelae in Kawasaki disease. Circulation J 2014; 78: 25212562.CrossRefGoogle ScholarPubMed
9. Cowles, RA, Berdon, WE. Bland-White-Garland syndrome of anomalous left coronary artery arising from the pulmonary artery (ALCAPA): a historical review. Pediatr Radiol 2007; 37: 890895.CrossRefGoogle ScholarPubMed
10. Pena, E, Nguyen, ET, Merchant, N, Dennie, G. Anomalous left coronary artery from pulmonary artery syndrome: not just a pediatric disease. Radiographics 2009; 29: 553565.CrossRefGoogle Scholar
11. Aslanger, E, Altun, I, Umman, B. Sudden cardiac arrest in a patient with an anomalous left main coronary artery originating from the pulmonary artery. Acta Cardiol 2009; 64: 835837.CrossRefGoogle Scholar
12. Krexi, L, Sheppard, MN. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a forgotten congenital cause of sudden death in the adult. Cardiovasc Pathol 2013; 22: 294297.CrossRefGoogle Scholar
13. Alsara, O, Kalavakunta, JK, Hajjar, V, Alsarah, A, Cho, N, Dhar, G. Surviving sudden cardiac death secondary to anomalous left coronary artery from the pulmonary artery: a case report and literature review. Heart Lung 2014; 43: 476480.CrossRefGoogle ScholarPubMed
14. Pachon, R, Bravo, C, Niemiera, M. Sudden cardiac death as a presentation of anomalous origin of the left coronary artery from pulmonary artery in a young adult. Eur Heart J Acute Cardiovasc Care 2015; 4: 589590.CrossRefGoogle Scholar
15. Davis, JA, Cecchin, F, Jones, TK, et al. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 2001; 37: 593597.CrossRefGoogle Scholar
16. Pelliccia, A. Congenital coronary artery anomalies in young patients: new perspectives for timely identification. J Am Coll Cardiol 2001; 37: 598600.CrossRefGoogle ScholarPubMed
17. Angelini, P. Novel imaging of coronary artery anomalies to assess their prevalence, the causes of clinical symptoms, and the risk of sudden cardiac death. Circ Cardiovasc Imaging 2014; 7: 747754.CrossRefGoogle ScholarPubMed
18. Mainwaring, RD, Reddy, VM, Reinhartz, O, et al. Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients. Ann Thorac Surg 2011; 92: 691697.CrossRefGoogle ScholarPubMed
19. Basso, C, Maron, BJ, Corrado, D, Thiene, G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35: 14931501.CrossRefGoogle ScholarPubMed
20. Frommelt, PC. Congenital coronary artery abnormalities predisposing to sudden cardiac death. PACE 2009; 32: S63S66.CrossRefGoogle ScholarPubMed
21. Poynter, JA, Williams, WG, McIntyre, S, Brothers, JA, Jacobs, ML, the Congenital Heart Surgeons Society AAOCA Working Group. Anomalous aortic origin of a coronary artery: a report from the Congenital Heart Surgeons Society Registry. World J Pediatr Congenit Heart Surg 2014; 5: 2230.CrossRefGoogle ScholarPubMed
22. Angelini, P. Congenital coronary artery ostial disease: a spectrum of anatomic variants with different pathophysiologies and prognoses. Texas Heart Institute J 2012; 39: 5559.Google ScholarPubMed
23. Mohlenkamp, S, Hort, W, Ge, J, Erbel, R. Update on myocardial bridging. Circulation 2002; 106: 26162622.CrossRefGoogle ScholarPubMed
24. Alegria, JR, Herrmann, J, Holmes, DR Jr, Lerman, A, Rihal, CS. Myocardial bridging. Eur Heart J 2005; 26: 11591168.CrossRefGoogle ScholarPubMed
25. Hill, SF, Sheppard, MN. Non-atherosclerotic coronary artery disease associated with sudden cardiac death. Heart 2010; 96: 11191125.CrossRefGoogle ScholarPubMed
26. Gowd, BM, Thompson, PD. Isolated myocardial bridging and exercise-related cardiac events. Int J Sports Med 2014; 35: 11451150.Google ScholarPubMed
27. Thompson, PD, Myerburg, RJ, Levine, BD, Udelson, JE, Kovacs, RJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 8: coronary artery disease. J Am Coll Cardiol 2015; 66: 24062411.CrossRefGoogle ScholarPubMed
4
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Acquired and congenital coronary artery abnormalities
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Acquired and congenital coronary artery abnormalities
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Acquired and congenital coronary artery abnormalities
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *