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In Vivo Detection of Coronary Artery Anomalies in Asymptomatic Athletes by Echocardiographic Screening

Paolo Zeppilli; Antonio dello Russo; Cesare Santini; Vincenzo Palmieri; Luigi Natale; Alessandro Giordano; Andrea Frustaci
Author and Funding Information

Affiliations: From the Centro Studi di Medicina dello Sport, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy

Affiliations: From the Centro Studi di Medicina dello Sport, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy

Affiliations: From the Centro Studi di Medicina dello Sport, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy

Affiliations: From the Centro Studi di Medicina dello Sport, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy,  From the Centro Studi di Medicina dello Sport, the Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy


1998 by the American College of Chest Physicians


Chest. 1998;114(1):89-93. doi:10.1378/chest.114.1.89
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Published online

Abstract

Background: Anomalous origin of coronary arteries (AOCA) is a rare congenital disease. Although it may have a benign course, it has been identified as a frequent cause of sports-related sudden death. Unfortunately, in vivo detection of AOCA is not easy, as individuals with this anomaly often are asymptomatic and show no signs of myocardial ischemia. Presently, transthoracic two-dimensional echocardiography (TTE) is the only noninvasive, widely available tool to visualize the ostia and first tracts of coronary arteries.

Objective: To assess the efficacy of TTE in the screening of AOCA in a large athletic population.

Study design: In a prospective study, we assessed the ostia and first tracts of coronary arteries in 3,650 subjects (mean age, 30±12 years) practicing different sports at various competitive levels. Subjects underwent a TTE examination in our laboratory for scientific or diagnostic purposes.

Results: Technically satisfactory echocardiograms were obtained in 3,504 subjects (96%); a clear visualization of the ostia and first tracts of both coronary arteries was obtained in 3,150 cases (90%). Three asymptomatic athletes (0.09%) were suspected to have an AOCA; two with a right coronary artery origin from the left sinus, and one with a left coronary artery origin from the right sinus. Diagnosis was confirmed by coronary angiography.

Conclusions: Our study indicated that AOCA is rare in asymptomatic athletes. Systematic and accurate exploration of coronary anatomy in athletes referred for a diagnostic TTE examination may be useful in identifying those with AOCA.


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