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Acquired and congenital coronary artery abnormalities

Published online by Cambridge University Press:  13 January 2017

Ming-Lon Young ,
Michael McLeary  and
Kak-Chen Chan
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
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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.

Keywords

Kawasaki diseaseanomalous left coronary artery from the pulmonary arteryanomalous origin of coronary artery from the opposite sinus of Valsalvamyocardial bridging
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Supplement S1: Sudden Cardiac Arrest in the Young: A Contemporary Perspective , January 2017 , pp. S31 - S35
Copyright
© Cambridge University Press 2017 

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