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Sudden Death: Differential Diagnosis and AOCA

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Congenital Anomalies of Coronary Arteries

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Abstract

Although rare, congenital coronary artery anomalies confer a relatively high risk of myocardial ischemia and represent one of the leading causes of sudden cardiac death (SCD) in young and apparently healthy athletes. The anomalous origin of a coronary artery (AOCA) from the opposite sinus of Valsalva is the most common life-threatening anomaly correlated with an increased risk of SCD, especially when associated with a proximal intramural and interarterial course between the aorta and the pulmonary artery. In the presence of AOCA, SCD is supposed to be caused by lethal ventricular arrhythmias due to myocardial ischemia. Although certain high-risk features have been identified, specific pathophysiological mechanisms related to SCD still remain poorly understood and optimal SCD risk stratification remains challenging. Echocardiography may be particularly helpful in the setting of screening, especially in young athletes, for the initial identification of AOCA, which can be then confirmed by more advanced imaging techniques. Because of its practical management complexity, AOCA requires a multidisciplinary approach, which may facilitate effective risk stratification and may have implications in long-term prognosis.

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Author information

Authors and Affiliations

  1. Sports Medicine Unit, AULSS 2 Marca Trevigiana, Treviso, Italy

    Barbara Barra

  2. Cardiothoracic Centre, Guy’s and St Thomas’ Hospital, London, UK

    Gherardo Finocchiaro

  3. King’s College London, London, UK

    Gherardo Finocchiaro

  4. Royal Brompton and Harefield Hospital, London, UK

    Gherardo Finocchiaro

  5. Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George’s, University of London, London, UK

    Gherardo Finocchiaro

Authors
  1. Barbara Barra
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  2. Gherardo Finocchiaro
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Correspondence to Gherardo Finocchiaro .

Editor information

Editors and Affiliations

  1. Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Hospital, Rome, Italy

    Gianfranco Butera

  2. Cardiac Surgery Unit, Policlinico San Donato, SAN DONATO MILANESE, Milano, Italy

    Alessandro Frigiola

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Barra, B., Finocchiaro, G. (2023). Sudden Death: Differential Diagnosis and AOCA. In: Butera, G., Frigiola, A. (eds) Congenital Anomalies of Coronary Arteries. Springer, Cham. https://doi.org/10.1007/978-3-031-36966-7_14

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  • DOI: https://doi.org/10.1007/978-3-031-36966-7_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-36965-0

  • Online ISBN: 978-3-031-36966-7

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