Syncope and coronary anomalies

R. Barriales-Villa1 and C. Morís2

1 Complexo Hospitalario de Pontevedra, Spain
2 Hospital Central Asturias, Spain

We have read with interest the article by Colivicchi et al.1 and while congratulating them on their work, we would like to make some comments.

Congenital anomalies of the coronary arteries are an important cause of sudden death in athletes, which should be excluded when one of these presents a syncope. In their work, the authors rule out cardiac disease in the 33 athletes studied, by means of an evaluation which includes a clinical history, physical examination, routine laboratory tests, a 12-lead electrocardiogram, Doppler echocardiography, 24-h electrocardiographic monitoring, exercise testing and an cardiac electrophysiological study.1

We are in complete agreement with the authors on the employment of Doppler echocardiography as a noninvasive technique in the diagnosis of the initial course of coronary anomalies, but it is known thatthere are a small percentage ofpatients with poor echocardiographic windows, which do not allow a complete and safe diagnosis of the initial course.2 Different semi-invasive techniques—transoesophageal echocardiography,3 helicoidal computedtomography,4 magnetic angioresonance5—have been proposed to alleviate this problem.

Have the authors employed any of these semi-invasive techniques or has conventional transthoracic echocardiography been satisfactory in ruling out the presence of coronary anomalies?

References

  1. Colivicchi F, Ammirati F, Biffi A, Verdile L, Pelliccia A, Santini M. Exercise-related syncope in young competitive athletes without evidence of structural heart disease: Clinical presentation and long-term outcome. Eur Heart J. 2002;23:1125–1130 doi:10.1053/euhj.2001.3042[Abstract/Free Full Text]
  2. Pelliccia A, Spataro A, Maron BJ. Prospective echocardiographic screening for coronary artery anomalies in 1360 elite competitive athletes. Am J Cardiol. 1993;72:978–979[Medline]
  3. Fernandes F, Alam M, Smith S, Khaja F. The role of transesophageal echocardiography in identifying anomalous coronary arteries. Circulation. 1993;88:2532–2540[Abstract]
  4. Barriales-Villa R, Morís C. Usefulness of helical computed tomography in the diagnosis of the initial course of coronary anomalies. Am J Cardiol. 2001;88:719–2540
  5. McConnell MV, Ganz P, Selwyn AP, Li W, Edelman RR, Manning WJ. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation. 1995;92:3158–3162[Abstract/Free Full Text]




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