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Congenital and Acquired Anomalies of Coronary Arteries

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Sport-related sudden cardiac death

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Abstract

Congenital and acquired diseases of coronary arteries are frequent causes of sudden cardiac death (SCD) in recreational and competitive sportsmen. Coronary atherosclerosis is responsible for the vast majority of SCD in middle-aged and older athletes, while the anomalous origin of a coronary artery from the “wrong” sinus of Valsalva is one of the most frequent causes in the younger ones. Regardless of the type of disease and mechanisms involved, SCD is usually the result of exercise-induced myocardial ischemia.

Congenital coronary artery anomalies are a rare, heterogeneous, group of malformations. Among them, the definition “anomalous origins of coronary arteries” include all the conditions in which one or more coronary branches originate differently from “normal”. The most common is the anomalous origin of the right coronary artery from the left sinus of Valsalva, while the one that seems associated with a greater risk of SCD is the origin of the left coronary artery from the right sinus of Valsalva. Exercise-induced ischemia depends mostly on the anatomy of the malformation and on different mechanisms that can coexist in the same subject.

Other congenital anomalies which can bring a risk of SCD, although often difficult to define, are myocardial “bridges” and coronary fistulae.

Among the acquired coronary anomalies, the most important is coronary atherosclerosis (CA). In athletes with CA, SCD can be the result of complications of a severe obstructive disease or rupture/erosion of unstable, non-obstructive plaques.

Other, less frequent causes of SCD can be the acquired coronary anomalies secondary to Kawasaki’s disease or to cocaine consumption.

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Authors and Affiliations

  1. Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy

    Paolo Zeppilli, Salvatore Francesco Gervasi & Vincenzo Palmieri

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  1. Paolo Zeppilli
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  2. Salvatore Francesco Gervasi
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  1. Ospedale P. Pederzoli, Peschiera del Garda, Italy

    Pietro Delise

  2. Catholic University of the Sacred Heart, Roma, Italy

    Paolo Zeppilli

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Zeppilli, P., Gervasi, S.F., Palmieri, V. (2022). Congenital and Acquired Anomalies of Coronary Arteries. In: Delise, P., Zeppilli, P. (eds) Sport-related sudden cardiac death. Springer, Cham. https://doi.org/10.1007/978-3-030-80447-3_7

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