In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening

Chest. 1998 Jul;114(1):89-93. doi: 10.1378/chest.114.1.89.


Background: Anomalous origin of coronary arteries (AOCA) is a rare congenital disease. Although it may have a benign course, it has been identified as a frequent cause of sports-related sudden death. Unfortunately, in vivo detection of AOCA is not easy, as individuals with this anomaly often are asymptomatic and show no signs of myocardial ischemia. Presently, transthoracic two-dimensional echocardiography (TTE) is the only noninvasive, widely available tool to visualize the ostia and first tracts of coronary arteries.

Objective: To assess the efficacy of TTE in the screening of AOCA in a large athletic population.

Study design: In a prospective study, we assessed the ostia and first tracts of coronary arteries in 3,650 subjects (mean age, 30+/-12 years) practicing different sports at various competitive levels. Subjects underwent a TTE examination in our laboratory for scientific or diagnostic purposes.

Results: Technically satisfactory echocardiograms were obtained in 3,504 subjects (96%); a clear visualization of the ostia and first tracts of both coronary arteries was obtained in 3,150 cases (90%). Three asymptomatic athletes (0.09%) were suspected to have an AOCA; two with a right coronary artery origin from the left sinus, and one with a left coronary artery origin from the right sinus. Diagnosis was confirmed by coronary angiography.

Conclusions: Our study indicated that AOCA is rare in asymptomatic athletes. Systematic and accurate exploration of coronary anatomy in athletes referred for a diagnostic TTE examination may be useful in identifying those with AOCA.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Arrhythmia, Sinus / etiology
  • Bradycardia / etiology
  • Bundle-Branch Block / etiology
  • Coronary Angiography
  • Coronary Vessel Anomalies / complications
  • Coronary Vessel Anomalies / diagnostic imaging*
  • Coronary Vessels / diagnostic imaging
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control
  • Echocardiography*
  • Female
  • Humans
  • Image Enhancement
  • Male
  • Mass Screening*
  • Middle Aged
  • Myocardial Ischemia / diagnostic imaging
  • Myocardial Ischemia / prevention & control
  • Prospective Studies
  • Sports*
  • Ventricular Premature Complexes / etiology