Daems Joelle J N, van Diepen Maarten A, de Mooij Splinter R E, Speleman Manou, Velthuis Sebastiaan, Damman Peter, Beijk Marcel, Hinderks Mark, Nijveldt Robin, Jorstad Harald T
Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
JACC Case Rep. 2025 Jun 25;30(16):104250. doi: 10.1016/j.jaccas.2025.104250.
Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly linked to increased risk of myocardial ischemia and sudden cardiac death, especially among athletes subjected to extreme physiological stress. The diagnostic and therapeutic strategies in highly active individuals remain challenging and represent important knowledge gaps.
We present 4 cases of elite athletes with AAOCA with a variety of characteristics and detail their clinical evaluation, imaging and functional assessment, risk stratification, treatment decisions, and longitudinal follow-up.
There are limited prospective data regarding the management of AAOCA in athletes. Autopsy studies have identified young age (<35 years), high exercise levels, and myocardial fibrosis as risk factors for sudden cardiac death. Moreover, the European Society of Cardiology on adult congenital heart disease recommends including age, level of exercise, and presence of high-risk anomaly features in risk assessment. This series highlights the complexities of managing AAOCA in athletes, and emphasizes the necessity for multimodality imaging in a context of multidisciplinary, individualized decision-making.
TAKE-HOME MESSAGES: A multimodality imaging approach is essential for early recognition, risk stratification, and clinical decision-making in AAOCA. Treatment decisions should be based on symptoms, presence of high-risk features, and inducible ischemia using complementary imaging modalities, with personalized recommendations supported by a multidisciplinary sports cardiology team.
冠状动脉异常起源（AAOCA）是一种罕见的先天性异常，与心肌缺血和心源性猝死风险增加有关，尤其是在承受极端生理压力的运动员中。对于高活动量个体的诊断和治疗策略仍然具有挑战性，且存在重要的知识空白。
我们报告4例具有不同特征的精英运动员AAOCA病例，并详细介绍了他们的临床评估、影像学和功能评估、风险分层、治疗决策及长期随访情况。
关于运动员AAOCA管理的前瞻性数据有限。尸检研究已确定年轻（<35岁）、高运动量和心肌纤维化是心源性猝死的危险因素。此外，欧洲心脏病学会关于成人先天性心脏病的指南建议在风险评估中纳入年龄、运动水平和高危异常特征的存在情况。本系列病例突出了运动员AAOCA管理的复杂性，并强调在多学科、个体化决策背景下进行多模态成像的必要性。
多模态成像方法对于AAOCA的早期识别、风险分层和临床决策至关重要。治疗决策应基于症状、高危特征的存在情况以及使用互补成像模式诱导的缺血情况，并由多学科运动心脏病学团队提供个性化建议。
