Chronicle of a death foretold. It is time for echocardiographic screening in young athletes

Abstract

Background: The novel "Chronicle of a death foretold" by Gabriel Garcia Marquez is a story of a sudden death which could have been prevented. In 1976, within the University of Maryland basketball program and only 8 weeks apart, two athletes died suddenly during physical exertion. They were affected by hypertrophic cardiomyopathy and Marfan syndrome and in both cases an echocardiogram would have prevented the tragic epilogue. This coincidence drew everyone's attention and experts' interest on sudden death in sports.

Methods and results: Even in recent Italian history, unexpected deaths continue to affect athletes but surprisingly any real knowledge regarding the numbers and the impact of those tragedies must take medical literature and non-medical press into consideration. Herein we report the clinical case of a 13-year-old patient with a bicuspid aortic valve, whose mother was alarmed by the news of a young boy who died because of an anomalous origin of coronary artery (AOCA) which had not been diagnosed at transthoracic echocardiography (TTE). Her obstinacy induced the physicians to repeat TTE and led to the same diagnosis in her son: actually, his right coronary artery originated from the opposite sinus of Valsalva. The suspicion was confirmed by coronary CT scan and, thanks to appropriate therapy, the boy now fares well.

Conclusions: AOCA is the second most common cause of sudden death in young athletes. Although AOCA is often undetectable at ECG, TTE increases sensitivity of preparticipation screening. It could therefore allow us to avoid such coincidences and prevent sudden juvenile death.

Keywords: Anomalous origin of coronary artery; Echocardiography; Screening; Sport cardiology; Sudden cardiac death.

Fig. 1

CT scan (a) and 3D-reconstruction (b) of RCA (*) arising from the opposite sinus of Valsalva with interarterial course.

Fig. 2

Causes of sudden cardiac death in athletes aged <35 years in the Veneto region of Italy (modified from Corrado et al. [10]). ARVC: arrhythmogenic right ventricular cardiomyopathy, AOCA: anomalous origin of coronary artery, CAD: coronary artery disease (of atherosclerotic nature), HCM: hypertrophic cardiomyopathy, DCM: dilated cardiomyopathy, MVP: mitral valve prolapse, CSD: conduction system disease, PE: pulmonary embolism.

Fig. 3

TTE of normal coronary arteries (parasternal short axis projection). Coronary ostia (a) and LCA bifurcation (b). CX: circumflex coronary artery, LAD: left anterior descending artery, LCA: left coronary artery, RCA: right coronary artery.