Coronary Artery Abnormalities and Sudden Cardiac Death

Anomalous origin of a coronary artery (AOCA) can be associated with sudden cardiac death (SCD), particularly in young athletes. The diagnosis usually can be made by transthoracic echocardiography. In the case of patients for whom this method is not diagnostic, other methods are available including transesophageal echocardiography, cardiac magnetic resonance imaging (CMRI), and computed tomographic (CT) angiography. The decision to intervene is dependent on the type of lesion, the course of the coronary artery, its known association with SCD, and any symptoms present at the time of diagnosis. For patients without symptoms who have lesions less clearly associated with SCD [e.g., anomalous origin of the right coronary artery (AORCA)], the decision to intervene is more controversial. Further prospective studies hopefully will elucidate the optimum treatment pathway for such patients.