Objectives: Recommendations regarding sports restriction are lacking for middle-aged athletes with anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). Methods: Sixty-three patients with ACAOS were subdivided into ACAOS with (n = 38) or without (n = 25) an interarterial course (IAC). Sports behavior, either competitive (COMP) or recreational (REC), was evaluated at the time of diagnosis and after a median follow-up of 4.2 years. Results: Mean age was 56 ± 11 years and 48 (76.2%) patients were engaged in sports. Three individuals (4.8%) were surgically corrected after diagnosis. Thirty-eight (60.3%) patients were aware of their diagnosis at follow-up and 12 (19.0%) were counseled by their physician about sports restrictions. Sports behavior at the time of diagnosis and at follow-up did not differ significantly, neither in patients engaged in COMP (17.5 vs. 12.7%, p = 0.619) nor those engaged in REC (58.7 vs. 61.9%, p = 0.856). Sport-related symptoms were not significantly different between ACAOS patients with and without IAC. No athlete had died at follow-up. Conclusions: The majority of middle-aged individuals with ACAOS were involved in sports activities at the time of diagnosis and at follow-up. Awareness and counseling about ACAOS diagnosis had no significant effect on sports behavior. IAC did not have an impact on sport-related symptoms, and outcomes were favorable in all athletes, regardless of surgical correction.

1.
Clark RA, Marler AT, Lin CK, McDonough RJ, Prentice RL, Malik JA, Villines TC, Hulten EA, Thomas DM, Slim AM: A review of anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) impact on major adverse cardiovascular events based on coronary computerized tomography angiography: a 6-year single center review. Ther Adv Cardiovasc Dis 2014; 8: 237–241.
2.
Lawless CE: Return-to-play decisions in athletes with cardiac conditions. Phys Sportsmed 2009; 37: 80–91.
3.
Gräni C, Benz DC, Schmied C, Vontobel J, Possner M, Clerc OF, Mikulicic F, Stehli J, Fuchs TA, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR: Prevalence and characteristics of coronary artery anomalies detected by coronary computed tomography angiography in 5 634 consecutive patients in a single centre in Switzerland. Swiss Med Wkly 2016; 146:w14294.
4.
Bria S, Chessa M, Abella R, Frigiola A, Bianco M, Palmieri V, Zeppilli P: Aborted sudden death in a young football player due to anomalous origin of the left coronary artery: successful surgical correction. J Cardiovasc Med 2008; 9: 834–838.
5.
Camarda J, Berger S: Coronary artery abnormalities and sudden cardiac death. Pediatr Cardiol 2012; 33: 434–438.
6.
Frommelt PC: Congenital coronary artery abnormalities predisposing to sudden cardiac death. Pacing Clin Electrophysiol 2009; 32 Suppl 2:S63–66.
7.
Harmon KG, Drezner JA, Maleszewski JJ, Lopez-Anderson M, Owens D, Prutkin JM, Asif IM, Klossner D, Ackerman MJ: Pathogeneses of sudden cardiac death in national collegiate athletic association athletes. Circ Arrhythm Electrophysiol 2014; 7: 198–204.
8.
Hill SF, Sheppard MN: A silent cause of sudden cardiac death especially in sport: congenital coronary artery anomalies. Br J Sports Med 2014; 48: 1151–1156.
9.
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: 1085–1092.
10.
Angelini P: Coronary artery anomalies: an entity in search of an identity. Circulation 2007; 115: 1296–1305.
11.
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: 1493–1501.
12.
Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R: Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004; 141: 829–834.
13.
Kim SY, Seo JB, Do KH, Heo JN, Lee JS, Song JW, Choe YH, Kim TH, Yong HS, Choi SI, Song KS, Lim TH: Coronary artery anomalies: classification and ECG-gated multi-detector row CT findings with angiographic correlation. Radiographics 2006; 26: 317–333; discussion 333–314.
14.
Lim JC, Beale A, Ramcharitar S: Anomalous origination of a coronary artery from the opposite sinus. Nat Rev Cardiol 2011; 8: 706–719.
15.
Lorenz EC, Mookadam F, Mookadam M, Moustafa S, Zehr KJ: A systematic overview of anomalous coronary anatomy and an examination of the association with sudden cardiac death. Rev Cardiovasc Med 2006; 7: 205–213.
16.
Gräni C, Benz DC, Steffen DA, Clerc OF, Schmied C, Possner M, et al: Outcome in middle-aged individuals with anomalous origin of the coronary artery from the opposite sinus: a matched cohort study. Eur Heart J 2017; 38: 2009–2016.
17.
Abbara S, Arbab-Zadeh A, Callister TQ, Desai MY, Mamuya W, Thomson L, Weigold WG: SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2009; 3: 190–204.
18.
Benz DC, Gräni C, Hirt Moch B, Mikulicic F, Vontobel J, Fuchs TA, Stehli J, Clerc OF, Possner M, Pazhenkottil AP, Gaemperli O, Buechel RR, Kaufmann PA: Minimized radiation and contrast agent exposure for coronary computed tomography angiography: first clinical experience on a latest generation 256-slice scanner. Acad Radiol 2016; 23: 1008–1014.
19.
Benz DC, Mikulicic F, Gräni C, Moret D, Possner M, Clerc OF, Studer Bruengger AA, Gaemperli O, Buechel RR, Pazhenkottil AP, Kaufmann PA: Long-term outcome prediction by functional parameters derived from coronary computed tomography angiography. Int J Cardiol 2017; 243: 533–537.
20.
Pazhenkottil AP, Husmann L, Buechel RR, Herzog BA, Nkoulou R, Burger IA, Vetterli A, Valenta I, Ghadri JR, von Schulthess P, Kaufmann PA: Validation of a new contrast material protocol adapted to body surface area for optimized low-dose CT coronary angiography with prospective ECG-triggering. Int J Cardiovasc Imaging 2010; 26: 591–597.
21.
Harris MA, Whitehead KK, Shin DC, Keller MS, Weinberg PM, Fogel MA: Identifying abnormal ostial morphology in anomalous aortic origin of a coronary artery. Ann Thorac Surg 2015; 100: 174–179.
22.
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 Cardiovasc Imaging 2012; 28: 1525–1532.
23.
Sundaram B, Patel S, Bogot N, Kazerooni EA: Anatomy and terminology for the interpretation and reporting of cardiac MDCT. 1. Structured report, coronary calcium screening, and coronary artery anatomy. AJR Am J Roentgenol 2009; 192: 574–583.
24.
Maron BJ, Mitchell JH: Revised eligibility recommendations for competitive athletes with cardiovascular abnormalities. Med Sci Sports Exerc 1994; 26:S223–226.
25.
Lamprecht M, Fischer A, Stamm H; Swiss Federal Office of Sports Statistics: Sport Schweiz 2008 – Das Sportverhalten der Schweizer Bevölkerung. http://www.baspo.admin.ch/internet/baspo/de/home/dokumentation.parsys.0001101.downloadList.17485.DownloadFile.tmp/basposportschweizde.pdf (accessed January 29, 2017).
26.
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: 1593–1601.
27.
Gräni C, Chappex N, Fracasso T, Vital C, Kellerhals C, Schmied C, Saguner AM, Trachsel LD, Eser P, Michaud K, Wilhelm M: Sports-related sudden cardiac death in Switzerland classified by static and dynamic components of exercise. Eur J Prev Cardiol 2016; 23: 1228–1236.
28.
Drezner JA, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, et al: Electrocardiographic interpretation in athletes: the “Seattle criteria.” Br J Sports Med 2013; 47: 122–124.
29.
Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, et al: Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 1422–1445.
30.
Gräni C, Senn O, Bischof M, Cippa PE, Hauffe T, Zimmerli L, Battegay E, Franzen D: Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study. BMJ Open 2015; 5:e007442.
31.
Van Hare GF, Ackerman MJ, Evangelista JA, Kovacs RJ, Myerburg RJ, Shafer KM, Warnes CA, Washington RL: Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities. Task Force 4: Congenital Heart Disease. A scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2015; 66: 2372–2384.
32.
Gräni C, Buechel RR, Kaufmann PA, Kwong RY: Multimodality imaging in individuals with anomalous coronary arteries. JACC Cardiovasc Imaging 2017; 10: 471–481.
33.
Gräni C, Benz DC, Schmied C, Vontobel J, Mikulicic F, Possner M, et al: Hybrid CCTA/SPECT myocardial perfusion imaging findings in patients with anomalous origin of coronary arteries from the opposite sinus and suspected concomitant coronary artery disease. J Nucl Cardiol 2017; 24: 226–234.
34.
Gräni C, Benz DC, Possner M, Clerc OF, Mikulicic F, Vontobel J, Stehli J, Fuchs TA, Pazhenkottil AP, Gaemperli O, Kaufmann PA, Buechel RR: Fused cardiac hybrid imaging with coronary computed tomography angiography and positron emission tomography in patients with complex coronary artery anomalies. Congenit Heart Dis 2017; 12: 49–57.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.