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European Heart Journal 2003 24(3):289; doi:10.1016/S0195-668X(02)00703-0
Copyright © 2003 by the European Society of Cardiology.
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Letters to the Editor

Syncope and Coronary Anomalies: Reply

Furio Colivicchi, Fabrizio Ammirati and Massimo Santini

Dipartimento per le Malattie Cardiovascolari, Ospedale S. Filippo Neri, Rome, Italy

Anomalous origin of coronary arteries is a congenital disease found in about 0.3% of all autopsies and in 0.5% of consecutive coronary angiograms.[l] Even if such a condition may showa benign clinical course, it hasbeen identified as possible cause of sports-related sudden death in young competitive athletes.2 However, anomalous origin of coronary arteries is rather difficult to detect in clinical practice. In fact, individuals with this disease are usually asymptomatic and may not show any significant clinical abnormality.3

Transthoracic echocardiography currently represents the only noninvasive, widely available methodology allowing the direct visualization of the ostia and first tracts of coronary arteries.4 In particular, echocardiography may be very helpful in young athletes as their chest conformation and the increase in coronary artery size due to intensive training may significantly favor the recognition of any relevant abnormality in the origin of the coronary arteries.4

Exercise-related syncope in young athletes may be due to the presence of anomalous origin of coronaryarteries.2 A careful echocardiographic examination of all athletes reporting such a symptom is therefore mandatory. In our series of 33 young competitive athletes with exercise-related syncope, transthoracic echocardiography was effective in visualizing both the ostia and first tracts of coronary arteries in all cases. Accordingly, no other semi-invasive methodology was required to exclude the presence of any abnormality in the origin of the coronary arteries.

References

  1. Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 1986;111:941–963[CrossRef][Web of Science][Medline]
  2. Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med. 1998;339:364–369[Abstract/Free Full Text]
  3. 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. 2001;38:1269–1270[Free Full Text]
  4. Zeppilli P, dello Russo A, Santini C, Palmieri V, Natale L, Giordano A, Frustaci A. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest. 1998;114:89–93[Abstract/Free Full Text]

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This Article
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