Congenital coronary artery anomalies in young patients: new perspectives for timely identification.

Sudden and unexpected cardiac deaths in young subjects are rare, but tragic events in competitive athletes assume high public profile, and that unavoidably raise questions regarding the underlying pathological causes and clinical strategies to prevent these catastrophes (1,2). Various pathological investigations have reported that several structural cardiovascular abnormalities are responsible for sudden death in young athletes, but hypertrophic cardiomyopathy is the most common disease in U.S. autopsy-based series, and right ventricular cardiomyopathy predominates in young Italian athletes (1,3–8). Nevertheless, congenital coronary artery anomalies (CCAA) are frequently found (in about 20% of cases), and they represent the second most frequent disease responsible for athletic field deaths (9–14). Specifically, the wrong sinus coronary artery origin, that is, the left main artery arising from the right anterior sinus (ALMCA), and the right coronary artery originating from the left sinus (ARCA), with a proximal course between aorta and pulmonary trunk, are the most frequent occurrences of CCAA.