title: Sudden cardiac arrest at the finish line: in coronary ectopia, the cause of ischemia is from intramural course, not ostial location.
abstract: A 26-year-old woman, a well-trained runner, had a sudden cardiac arrest just before crossing the finish line of a marathon. She was rapidly resuscitated and was later found to have an ectopic origin of the left coronary artery. This anomaly was surgically repaired by translocating the ostium from the right to the left sinus of Valsalva. Her difficult postoperative course prompted further coronary evaluation, which revealed severe stenosis of the neoostium. The patient underwent a second operation: this time, the stenosis was bypassed via a left internal mammary artery-to-left anterior descending coronary artery (LAD) graft. Hypoplasia of the LAD and spasm during manipulation caused the graft to fail, necessitating double-stent angioplasty of the left main ostium and the LAD 2 months later. At the patient's 6-month follow-up examination, she had no further evidence of functional ischemia, and she resumed jogging. Because the mode and mechanism of the patient's condition and events were documented in unusual detail, this case furthers our understanding of sudden cardiac arrest in athletes who have rare coronary anomalies. We conclude that ectopia of a coronary artery does not itself cause potentially fatal ischemia. Rather, these events are due to the ectopic artery's intramural proximal course within the aortic media, which might result in critical stenosis by means of hypoplasia or lateral compression of the artery.
authors.affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.
authors.forename: Steven
authors.initials: S
authors.lastname: Joggerst
authors.affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.
authors.forename: Jorge
authors.initials: J
authors.lastname: Monge
authors.affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.
authors.forename: Carlo
authors.initials: C
authors.lastname: Uribe
authors.affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.
authors.forename: Scott
authors.initials: S
authors.lastname: Sherron
authors.affiliation: Department of Cardiology, Texas Heart Institute, Houston, Texas 77030.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angelini
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography / Q000379:methods; D005112:Extracorporeal Circulation / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000601:surgery; D013177:Sports; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
chemical_list: D014662:Vasoconstrictor Agents
keywords: Cardiac surgical procedures; coronary stenosis/etiology; coronary vessel anomalies/classification/complications/diagnosis/surgery; coronary vessels/ultrasonography; death, sudden, cardiac/etiology/pathology/prevention & control; sinus of Valsalva/abnormalities; treatment outcome; ultrasonography, interventional