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A Hidden Threat: Anomalous Aortic Origins of the Coronary Arteries in Athletes

  • Sports Cardiology (M Wasfy, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Anomalous aortic origins of the coronary arteries (AAOCA) are a primary cause of sudden cardiac death in athletes. This review will detail the epidemiology, pathophysiology, and risk stratification of AAOCA, while also highlighting return-to-play considerations for athletes.

Recent findings

Sport pre-participation cardiovascular screening methods lack sensitivity and specificity in the identification of AAOCA. For the symptomatic athlete, clinicians must maintain a heightened clinical suspicion for AAOCA in order to proceed with appropriate cardiac imaging and functional assessments. Anomalous origin of the left coronary artery with an interarterial course is considered high-risk and requires sport restriction until surgical correction. In contrast, risks associated with anomalous origin of the right coronary artery are controversial; thus, management and sports eligibility decisions may incorporate principles of shared decision-making.

Summary

Management options for athletes with AAOCA are complex, requiring a comprehensive clinical evaluation. While advances in multimodality cardiovascular imaging and physiologic functional assessments have improved AAOCA risk stratification, best practice treatment strategies for some AAOCA subtypes remain uncertain. As such, clinical management and sport eligibility decisions require an individualized approach. Future prospective data will guide optimization of treatment strategies for athletes with AAOCA.

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References and Recommended Reading

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  1. Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007;115(10):1296–305. https://doi.org/10.1161/circulationaha.106.618082.

    Article  PubMed  Google Scholar 

  2. 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(6):1493–501. https://doi.org/10.1016/s0735-1097(00)00566-0.

    Article  CAS  PubMed  Google Scholar 

  3. Maron BJ. Sudden death in young athletes. N Engl J Med. 2003;349(11):1064–75. https://doi.org/10.1056/nejmra022783.

    Article  CAS  PubMed  Google Scholar 

  4. Corrado D, Schmied C, Basso C, Borjesson M, Schiavon M, Pelliccia A, et al. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J. 2011;32(8):934–44. https://doi.org/10.1093/eurheartj/ehq482.

    Article  PubMed  Google Scholar 

  5. Hill SF, Sheppard MN. A silent cause of sudden cardiac death especially in sport: congenital coronary artery anomalies. Br J Sports Med. 2014;48(15):1151–6. https://doi.org/10.1136/bjsports-2013-092195.

    Article  PubMed  Google Scholar 

  6. • Gräni C, Buechel RR, Kaufmann PA, Kwong RY. Multimodality imaging in individuals with anomalous coronary arteries. JACC Cardiovasc Imaging. 2017;10(4):471–81. https://doi.org/10.1016/j.jcmg.2017.02.004. This review details recent advances in multimodality cardiovascular imaging of AAOCA.

    Article  PubMed  Google Scholar 

  7. Kimbiris D, Iskandrian AS, Segal BL, Bemis CE. Anomalous aortic origin of coronary arteries. Circulation. 1978;58(4):606–15. https://doi.org/10.1161/01.cir.58.4.606.

    Article  CAS  PubMed  Google Scholar 

  8. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–92. https://doi.org/10.1161/circulationaha.108.804617.

    Article  PubMed  Google Scholar 

  9. Krasuski RA, Magyar D, Hart S, Kalahasti V, Lorber R, Hobbs R, et al. Long-term outcome and impact of surgery on adults with coronary arteries originating from the opposite coronary cusp. Circulation. 2011;123(2):154–62. https://doi.org/10.1161/circulationaha.109.921106.

    Article  PubMed  Google Scholar 

  10. Barry MJ, Edgman-Levitan S. Shared decision making — the pinnacle of patient-centered care. N Engl J Med. 2012;366(9):780–1. https://doi.org/10.1056/nejmp1109283.

    Article  CAS  PubMed  Google Scholar 

  11. • Baggish AL, Ackerman MJ, Lampert R. Competitive sport participation among athletes with heart disease: a call for a paradigm shift in decision making. Circulation. 2017;136(17):1569–71. https://doi.org/10.1161/circulationaha.117.029639. Baggish and colleagues discuss the evolution of the physicians’ role in determining eligibility for sport participation and call for a shift from paternalism toward shared decision-making.

    Article  PubMed  Google Scholar 

  12. Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am Heart J. 1989;117(2):418–34. https://doi.org/10.1016/0002-8703(89)90789-8.

    Article  CAS  PubMed  Google Scholar 

  13. Angelini P, Villason S, Chan AV Jr, Diez JG. Normal and anomalous coronary arteries in humans. Part 1: historical background. Coronary anery anorulies: a comprehensfue approach. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 27–79.

    Google Scholar 

  14. •• Cheezum MK, Liberthson RR, Shah NR, Villines TC, O’Gara PT, Landzberg MJ, et al. Anomalous aortic origin of a coronary artery from the inappropriate sinus of Valsalva. J Am Coll Cardiol. 2017;69(12):1592–608. https://doi.org/10.1016/j.jacc.2017.01.031. In this review, the authors perform a comprehensive analysis of invasive and non-invasive studies to provide a contemporary estimate of the prevalence of AAOCA, ALCA, and ARCA. Cheezum and colleagues also summarize imaging modalities and provide relevant visual examples.

    Article  PubMed  Google Scholar 

  15. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992;20(3):640–7. https://doi.org/10.1016/0735-1097(92)90019-j.

    Article  CAS  PubMed  Google Scholar 

  16. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, Demographic, and Pathological profiles. JAMA. 1996;276(3):199. https://doi.org/10.1001/jama.1996.03540030033028.

    Article  CAS  PubMed  Google Scholar 

  17. Alexander RW, Griffith GC. Anomalies of the coronary arteries and their clinical significance. Circulation. 1956;14(5):800–5. https://doi.org/10.1161/01.cir.14.5.800.

    Article  CAS  PubMed  Google Scholar 

  18. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593. https://doi.org/10.1001/jama.296.13.1593.

    Article  CAS  PubMed  Google Scholar 

  19. Harmon KG, Drezner JA, Maleszewski JJ, Lopez-Anderson M, Owens D, Prutkin JM, et al. Pathogeneses of sudden cardiac death in national collegiate athletic association athletes. Circ Arrhythm Electrophysiol. 2014;7(2):198–204. https://doi.org/10.1161/circep.113.001376.

    Article  PubMed  Google Scholar 

  20. Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, et al. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med. 2004;141(11):829. https://doi.org/10.7326/0003-4819-141-11-200,412,070-00005.

    Article  PubMed  Google Scholar 

  21. Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol. 1998;29(7):689–95. https://doi.org/10.1016/s0046-8177(98)90277-5.

    Article  CAS  PubMed  Google Scholar 

  22. Cheitlin MD, De Castro CM, McAllister HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva: a not-so-minor congenital anomaly. Circulation. 1974;50(4):780–7. https://doi.org/10.1161/01.cir.50.4.780.

    Article  CAS  PubMed  Google Scholar 

  23. •• Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(14). https://doi.org/10.1161/cir.0000000000000603. This document contains the latest management guidelines for the evaluation and surgical correction of AAOCA in the general population. Athlete-specific guidelines were last issued by the AHA/ACC in 2015 (see reference #54).

  24. Zeltser I, Cannon B, Silvana L, Fenrich A, George J, Schleifer J, et al. Lessons learned from preparticipation cardiovascular screening in a state funded program. Am J Cardiol. 2012;110(6):902–8. https://doi.org/10.1016/j.amjcard.2012.05.018.

    Article  PubMed  Google Scholar 

  25. Eckart RE, Shry EA, Burke AP, McNear JA, Appel DA, Castillo-Rojas LM, et al. Sudden death in young adults. J Am Coll Cardiol. 2011;58(12):1254–61. https://doi.org/10.1016/j.jacc.2011.01.049.

    Article  PubMed  Google Scholar 

  26. De Noronha SV, Sharma S, Papadakis M, Desai S, Whyte G, Sheppard MN. Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study. Heart. 2009;95(17):1409–14. https://doi.org/10.1136/hrt.2009.168369.

    Article  PubMed  Google Scholar 

  27. Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42(11):1959–63. https://doi.org/10.1016/j.jacc.2003.03.002.

    Article  PubMed  Google Scholar 

  28. Burke AP, Farb A, Virmani R, Goodin J, Smialek JE. Sports-related and non-sports-related sudden cardiac death in young adults. Am Heart J. 1991;121(2):568–75. https://doi.org/10.1016/0002-8703(91)90727-y.

    Article  CAS  PubMed  Google Scholar 

  29. Chugh SS, Weiss JB. Sudden cardiac death in the older athlete. J Am Coll Cardiol. 2015;65(5):493–502. https://doi.org/10.1016/j.jacc.2014.10.064.

    Article  PubMed  Google Scholar 

  30. Kim JH, Malhotra R, Chiampas G, D’Hemecourt P, Troyanos C, Cianca J, et al. Cardiac Arrest during long-distance running races. N Engl J Med. 2012;366(2):130–40. https://doi.org/10.1056/nejmoa1106468.

    Article  CAS  PubMed  Google Scholar 

  31. Poynter JA, Williams WG, McIntyre S, Brothers JA, Jacobs ML, Overman D, et al. Anomalous aortic origin of a coronary artery: a report from the Congenital Heart Surgeons Society Registry. World J Pediatr Congenit Heart Surg. 2014;5(1):22–30. https://doi.org/10.1177/2150135113516984.

    Article  PubMed  Google Scholar 

  32. Peñalver JM, Mosca RS, Weitz D, Phoon CK. Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord. 2012;12(1):83. https://doi.org/10.1186/1471-2261-12-83.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Virmani R, Chun PKC, Goldstein RE, Robinowitz M, McAllister HA. Acute takeoffs of the coronary arteries along the aortic wall and congenital coronary ostial valve-like ridges: association with sudden death. J Am Coll Cardiol. 1984;3(3):766–71. https://doi.org/10.1016/s0735-1097(84)80253-3.

    Article  CAS  PubMed  Google Scholar 

  34. Frommelt PC. Congenital coronary artery abnormalities predisposing to sudden cardiac death. Pacing Clin Electrophysiol. 2009;32:S63–S6. https://doi.org/10.1111/j.1540-8159.2009.02387.x.

    Article  PubMed  Google Scholar 

  35. Angelini P, Uribe C, Monge J, Tobis JM, Elayda MA, Willerson JT. Origin of the right coronary artery from the opposite sinus of Valsalva in adults: characterization by intravascular ultrasonography at baseline and after stent angioplasty. Catheter Cardiovasc Interv. 2015;86(2):199–208. https://doi.org/10.1002/ccd.26069.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Angelini P, Velasco JA, Ott D, Khoshnevis GR. Anomalous coronary artery arising from the opposite sinus: descriptive features and pathophysiologic mechanisms, as documented by intravascular ultrasonography. J Invasive Cardiol. 2003;15(9):507–14.

    PubMed  Google Scholar 

  37. Brothers J, Gaynor JW, Paridon S, Lorber R, Jacobs M. Anomalous aortic origin of a coronary artery with an interarterial course: understanding current management strategies in children and young adults. Pediatr Cardiol. 2009;30(7):911–21. https://doi.org/10.1007/s00246-009-9461-y.

    Article  PubMed  Google Scholar 

  38. Taylor AJ, Byers JP, Cheitlin MD, Virmani R. Anomalous right or left coronary artery from the contralateral coronary sinus: “high-risk” abnormalities in the initial coronary artery course and heterogeneous clinical outcomes. Am Heart J. 1997;133(4):428–35. https://doi.org/10.1016/s0002-8703(97)70184-4.

    Article  CAS  PubMed  Google Scholar 

  39. Gräni C, Kaufmann PA, Windecker S, Buechel RR. Diagnosis and management of anomalous coronary arteries with a malignant course. Interv Cardiol Rev. 2019;14(2):83. https://doi.org/10.15420/icr.2019.1.1.

    Article  Google Scholar 

  40. Frommelt PC, Frommelt MA, Tweddell JS, Jaquiss RDB. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol. 2003;42(1):148–54. https://doi.org/10.1016/s0735-1097(03)00503-5.

    Article  PubMed  Google Scholar 

  41. • Angelini P, Uribe C. Anatomic spectrum of left coronary artery anomalies and associated mechanisms of coronary insufficiency. Catheter Cardiovasc Interv. 2018;92(2):313–21. https://doi.org/10.1002/ccd.27656. Angelini and colleagues illustrate the utility of intravascular ultrasound and the importance of intramural course as a high-risk feature in AAOCA.

    Article  PubMed  Google Scholar 

  42. Angelini P, Flamm SD. Newer concepts for imaging anomalous aortic origin of the coronary arteries in adults. Catheter Cardiovasc Interv. 2007;69(7):942–54. https://doi.org/10.1002/ccd.21140.

    Article  PubMed  Google Scholar 

  43. Angelini P, Walmsley RP, Libreros A, Ott DA. Symptomatic anomalous origination of the left coronary artery from the opposite sinus of Valsalva. Clinical presentations, diagnosis, and surgical repair. Tex Heart Inst J. 2006;33(2):171–9.

    PubMed  PubMed Central  Google Scholar 

  44. Lee SE, Yu CW, Park K, Park KW, Suh J-W, Cho Y-S, et al. Physiological and clinical relevance of anomalous right coronary artery originating from left sinus of Valsalva in adults. Heart. 2016;102(2):114–9. https://doi.org/10.1136/heartjnl-2015-308,488.

    Article  CAS  PubMed  Google Scholar 

  45. Molossi S, Martínez-Bravo LE, Mery CM. Anomalous aortic origin of a coronary artery. Method Debakey Cardiovasc J. 2019;15(2):111–21. https://doi.org/10.14797/mdcj-15-2-111.

    Article  Google Scholar 

  46. •• Molossi S, Agrawal H, Mery CM, Krishnamurthy R, Masand P, Sexson Tejtel SK, et al. Outcomes in anomalous aortic origin of a coronary artery following a prospective standardized approach. Circulation: Cardiovascular Interventions. 2020;13(2):e008445. https://doi.org/10.1161/circinterventions.119.008445. This study from a dedicated Coronary Anomalies Program summarizes outcomes of patients with AAOCA managed in a standardized manner. Prospective registries such as this are critical to advancing understanding of AAOCA.

  47. Zeppilli P, dello Russo A, Santini C, Palmieri V, Natale L, Giordano A, et al. In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening. Chest. 1998;114(1):89–93. https://doi.org/10.1378/chest.114.1.89.

    Article  CAS  PubMed  Google Scholar 

  48. Weiner RB, Wang F, Hutter AM Jr, Wood MJ, Berkstresser B, McClanahan C, et al. The feasibility, diagnostic yield, and learning curve of portable echocardiography for out-of-hospital cardiovascular disease screening. J Am Soc Echocardiogr. 2012;25(5):568–75. https://doi.org/10.1016/j.echo.2012.01.010.

    Article  PubMed  Google Scholar 

  49. Hoyt WJ, Dean PN, Schneider DS, Conaway MR, Kramer CM, Battle RW. Coronary artery evaluation by screening echocardiogram in intercollegiate athletes. Med Sci Sports Exerc. 2016;49(5):863–9. https://doi.org/10.1249/mss.0000000000001182.

    Article  Google Scholar 

  50. Frommelt PC, Berger S, Pelech AN, Bergstrom S, Williamson JG. Prospective identification of anomalous origin of left coronary artery from the right sinus of Valsalva using transthoracic echocardiography: importance of color Doppler flow mapping. Pediatr Cardiol. 2001;22(4):327–32. https://doi.org/10.1007/s002460010239.

    Article  CAS  PubMed  Google Scholar 

  51. Lorber R, Srivastava S, Wilder TJ, McIntyre S, Decampli WM, Williams WG, et al. Anomalous aortic origin of coronary arteries in the young. JACC Cardiovasc Imaging. 2015;8(11):1239–49. https://doi.org/10.1016/j.jcmg.2015.04.027.

    Article  PubMed  Google Scholar 

  52. Brown LM, Duffy CE, Mitchell C, Young L. A practical guide to pediatric coronary artery imaging with echocardiography. J Am Soc Echocardiogr: official publication of the American Society of Echocardiography. 2015;28(4):379–91. https://doi.org/10.1016/j.echo.2015.01.008.

    Article  Google Scholar 

  53. Pelliccia A, Spataro A, Maron BJ. Prospective echocardiographic screening for coronary artery anomalies in 1,360 elite competitive athletes. Am J Cardiol. 1993;72(12):978–9. https://doi.org/10.1016/0002-9149(93)91120-7.

    Article  CAS  PubMed  Google Scholar 

  54. Van Hare GF, Ackerman MJ, Evangelista J-AK, Kovacs RJ, Myerburg RJ, Shafer KM, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 4: congenital heart disease. J Am Coll Cardiol. 2015;66(21):2372–84. https://doi.org/10.1016/j.jacc.2015.09.036.

    Article  PubMed  Google Scholar 

  55. Cheezum MK, Ghoshhajra B, Bittencourt MS, Hulten EA, Bhatt A, Mousavi N, et al. Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA. Eur Heart J Cardiovasc Imaging. 2017;18(2):224–35. https://doi.org/10.1093/ehjci/jev323.

    Article  PubMed  Google Scholar 

  56. Miller JA, Anavekar NS, El Yaman MM, Burkhart HM, Miller AJ, Julsrud PR. Computed tomographic angiography identification of intramural segments in anomalous coronary arteries with interarterial course. Int J Card Imaging. 2012;28(6):1525–32. https://doi.org/10.1007/s10554-011-9936-9.

    Article  Google Scholar 

  57. Fuchs TA, Stehli J, Bull S, Dougoud S, Clerc OF, Herzog BA, et al. Coronary computed tomography angiography with model-based iterative reconstruction using a radiation exposure similar to chest X-ray examination. Eur Heart J. 2014;35(17):1131–6. https://doi.org/10.1093/eurheartj/ehu053.

    Article  PubMed  PubMed Central  Google Scholar 

  58. McConnell MV, Ganz P, Selwyn AP, Li W, Edelman RR, Manning WJ. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation. 1995;92(11):3158–62. https://doi.org/10.1161/01.CIR.92.11.3158.

    Article  CAS  PubMed  Google Scholar 

  59. Finocchiaro G, Behr ER, Tanzarella G, Papadakis M, Malhotra A, Dhutia H, et al. Anomalous coronary artery origin and sudden cardiac death. JACC: Clinical Electrophysiology. 2019;5(4):516–22. https://doi.org/10.1016/j.jacep.2018.11.015.

    Article  PubMed  Google Scholar 

  60. Bluemke DA, Achenbach S, Budoff M, Gerber TC, Gersh B, Hillis LD, et al. Noninvasive coronary artery imaging. Circulation. 2008;118(5):586–606. https://doi.org/10.1161/circulationaha.108.189695.

    Article  PubMed  Google Scholar 

  61. Shi H, Aschoff AJ, Brambs H-J, Hoffmann MHK. Multislice CT imaging of anomalous coronary arteries. Eur Radiol. 2004;14(12):2172–81. https://doi.org/10.1007/s00330-004-2490-2.

    Article  PubMed  Google Scholar 

  62. Nissen SE, Yock P. Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation. 2001;103(4):604–16. https://doi.org/10.1161/01.cir.103.4.604.

    Article  CAS  PubMed  Google Scholar 

  63. Kragel AH, Roberts WC. Anomalous origin of either the right or left main coronary artery from the aorta with subsequent coursing between aorta and pulmonary trunk: analysis of 32 necropsy cases. Am J Cardiol. 1988;62(10 Pt 1):771–7. https://doi.org/10.1016/0002-9149(88)91220-9.

    Article  CAS  PubMed  Google Scholar 

  64. Brothers J, Carter C, McBride M, Spray T, Paridon S. Anomalous left coronary artery origin from the opposite sinus of Valsalva: evidence of intermittent ischemia. J Thorac Cardiovasc Surg. 2010;140(2):e27–e9. https://doi.org/10.1016/j.jtcvs.2009.06.029.

    Article  PubMed  Google Scholar 

  65. Graham TP, Driscoll DJ, Gersony WM, Newburger JW, Rocchini A, Towbin JA. Task force 2: congenital heart disease. J Am Coll Cardiol. 2005;45(8):1326–33. https://doi.org/10.1016/j.jacc.2005.02.009.

    Article  PubMed  Google Scholar 

  66. Sharma V, Burkhart HM, Dearani JA, Suri RM, Daly RC, Park SJ, et al. Surgical unroofing of anomalous aortic origin of a coronary artery: a single-center experience. Ann Thorac Surg. 2014;98(3):941–5. https://doi.org/10.1016/j.athoracsur.2014.04.114.

    Article  PubMed  Google Scholar 

  67. Mainwaring RD, Murphy DJ, Rogers IS, Chan FP, Petrossian E, Palmon M, et al. Surgical repair of 115 patients with anomalous aortic origin of a coronary artery from a single institution. World J Pediatr Congenit Heart Surg. 2016;7(3):353–9. https://doi.org/10.1177/2150135116641892.

    Article  PubMed  Google Scholar 

  68. Frommelt PC, Sheridan DC, Berger S, Frommelt MA, Tweddell JS. Ten-year experience with surgical unroofing of anomalous aortic origin of a coronary artery from the opposite sinus with an interarterial course. J Thorac Cardiovasc Surg. 2011;142(5):1046–51. https://doi.org/10.1016/j.jtcvs.2011.02.004.

    Article  PubMed  Google Scholar 

  69. Mery CM, De León LE, Molossi S, Sexson-Tejtel SK, Agrawal H, Krishnamurthy R, et al. Outcomes of surgical intervention for anomalous aortic origin of a coronary artery: a large contemporary prospective cohort study. J Thorac Cardiovasc Surg. 2018;155(1):305–19.e4. https://doi.org/10.1016/j.jtcvs.2017.08.116.

    Article  PubMed  Google Scholar 

  70. Fedoruk LM, Kern JA, Peeler BB, Kron IL. Anomalous origin of the right coronary artery: right internal thoracic artery to right coronary artery bypass is not the answer. J Thorac Cardiovasc Surg. 2007;133(2):456–60. https://doi.org/10.1016/j.jtcvs.2006.10.011.

    Article  PubMed  Google Scholar 

  71. • Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, et al. Recommendations for multimodality assessment of congenital coronary anomalies: a guide from the American Society of Echocardiography: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr: official publication of the American Society of Echocardiography. 2020;33(3):259–94. https://doi.org/10.1016/j.echo.2019.10.011. This guideline document from the American Society of Echocardiography describes methods for identifying and characterizing AAOCA with a focus on echocardiography.

    Article  Google Scholar 

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Dr. Kim is supported by the National Institute of Health (K23 HL128795).

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  1. Division of Cardiology, Emory Clinical Cardiology Research Institute, Emory University School of Medicine, 1462 Clifton Road, NE, Suite 502, Atlanta, GA, 30322, USA

    Jason Tso MD, Casey G. Turner MSc & Jonathan H. Kim MD, MSc

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Tso, J., Turner, C.G. & Kim, J.H. A Hidden Threat: Anomalous Aortic Origins of the Coronary Arteries in Athletes. Curr Treat Options Cardio Med 22, 67 (2020). https://doi.org/10.1007/s11936-020-00859-1

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