Coronary artery abnormalities are rare. Davis et al11 examined proximal coronary artery anatomy in 2388 pediatric and adolescent patients referred for echocardiography over a 3-year period and found four children with anomalous origin of either the left or right proximal coronary artery for an incidence of 0.17%.
While these congenital conditions are rare and may have a benign course, they are a frequent cause of sudden death in athletes. A number of coronary artery abnormalities have been reported in athletes who have died suddenly, and these are listed in Table 4-4. The most common abnormality is the anomalous origin of the left main coronary artery from the right sinus of Valsalva rather than its normal origin from the left sinus. As seen in Figure 4-3, after originating from the right sinus, the anom-
Normal anatomy Anomalous origin of the left main coronary artery
Figure 4-3 Comparison of normal origin of the left main coronary artery with anomalous origin of the left main coronary artery from the right sinus of Valsalva. LAD, left anterior descending artery; LC, left circumflex artery; PA, pulmonary artery; RC, right coronary artery.
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