Congenital Anomaly of Left Coronary Artery in Young Athletes

Abstract

At the autopsy of a 16 year old boy who had died while playing basketball, both coronary arteries were found to originate from a displaced right cusp of the aortic valve. There was also evidence of a diffuse widespread bilateral pulmonary inflammatory process. The left branch of the coronary artery which was stenosed at its beginning subsequently passed between aorta and pulmonary artery. The right branch crossed through the sulcus between aorta and vena cava. The abnormal distribution of myocardial blood due to the vascular anomaly is held to have been an essential prerequisite for but not the cause of the sudden death. Nor could exercise as such have caused the fatal collapse. Significance is attached to the part played by the respiratory infection in initiating the terminal episode. In interpreting the mechanism of the death a distinction is made between the chronic sequelae of the congenital vascular anomaly and the factors responisble for the fatal syncope. Though without the former the fatal collapse would not have taken place. Ventricular fibrillation or asystole, the common final mediators of sudden unheralded cardiac death, are not likely to have occurred but for the superimposed pulmonary infection. Attention is given to the fact that the ''terminal'' cardiac event may be reversible.