Valve-sparing aortic root replacement after neonatal arterial switch operation.

Arterial switch operations (ASO) are lifesaving procedures performed on neonates to treat transposition of the great arteries. However, future operations on the neoaorta may be required due to dilation. We present a case of a 25-year-old female who presented with dilation of her neoaorta and required a David procedure. Her previous ASO resulted in an anterior lie of the pulmonary artery in front of the neoaorta, with both coronary arteries coming off anteriorly. We describe our approach to performing a David procedure on this patient with this unique anatomy.

Spontaneous Coronary Artery Dissection and Its Association With Fibromuscular Dysplasia and Other Vascular Abnormalities.

Fibromuscular dysplasia (FMD) has recently been associated with spontaneous coronary artery dissection (SCAD). We sought to further elucidate the association of FMD with SCAD. We performed a retrospective cohort review of patients with SCAD evaluated at our institution from 2008 to 2019. Baseline characteristics, coronary angiographic data, and screening for FMD were recorded. In patients who completed screening for FMD, variables were compared between patients with FMD and those without. We identified 51 patients with SCAD, all of whom were female, with a mean age of 46.8 years. A quarter of patients underwent percutaneous coronary intervention (PCI) and half of those suffered a complication during PCI. 78% of patients underwent complete screening for FMD, of which 63% were diagnosed with multifocal FMD. Vascular abnormalities other than FMD were found in 70% of screened patients. Patients with FMD were older than those without FMD (50.7 vs 42.6 years, p = 0.006). FMD was more frequently associated with type 2 SCAD (84% vs 47%, p = 0.025), tortuous non-SCAD coronaries (96% vs 53%, p = 0.002), and other vascular abnormalities (84% vs 47%, p = 0.03). In conclusion, the majority of patients within the all-female cohort with SCAD were found to have FMD. Other vascular abnormalities were also common. Patients with FMD were older and were more likely to have type 2 SCAD, tortuous non-SCAD coronary arteries, and other vascular abnormalities.

Athlete Cardiovascular Concerns in the Training Room: What Do I Do If ?

Cardiac disease can present in the training room through three portals: the preparticipation history and physical may identify concerns, the athlete may present with symptoms, or screening modalities may demonstrate abnormal findings. Training-related cardiovascular remodeling can mimic real disease, therefore providers must be able to separate the two. Sports medicine providers must be knowledgeable in how these present and how to care for these concerns to ensure proper care and avoid unnecessary restrictions of athletes. This article discusses 10 common cardiac concerns that can arise in the training room.

Coronary Artery Evaluation by Screening Echocardiogram in Intercollegiate Athletes.

INTRODUCTION: Coronary artery anomalies are the second most common congenital cause of sudden cardiac death in young athletes. Some centers have advocated for limited transthoracic echocardiogram (TTE) protocols in the screening of college athletes, which may miss important causes of sudden cardiac death. PURPOSE: The purpose of this study was to evaluate the ability of screening TTE to determine the origin and proximal course of the coronary arteries in intercollegiate athletes. METHODS: An institutional review board-approved retrospective review of all incoming National Collegiate Athletic Association Division-I athletes at a single institution for the 2013-2014 academic year was performed. Two pediatric cardiologists independently reviewed all TTE studies for right coronary artery (RCA) and left coronary artery (LCA) ostia, proximal course, and measurable course. Proximal course was defined as a measurable course >1 cm for the RCA and a measurable course >1 cm or observation of the bifurcation for the LCA. Measurable course was defined as the maximum continuously observable distance of coronary artery from a clearly delineable ostium. Results were compared among athlete characteristics, and interobserver reliability was evaluated. RESULTS: Chart review identified 146 athletes, representing 22 sports and 6 ethnicities. No coronary anomalies were found. The average measurable course was 2.1 cm for the RCA and 1.5 cm for the LCA. Both readers observed the RCA ostium in 143 athletes (98%), LCA ostium in 143 athletes (98%), RCA proximal course in 119 athletes (82%), and LCA proximal course in 118 athletes (81%). Statistical analysis showed good interobserver reliability for observation of the ostia and proximal course. CONCLUSIONS: The origin and proximal course of the coronary arteries were readily and reliably observed in the majority of athletes, suggesting coronary artery evaluation should be included in athlete screening TTE protocols.

Cardiovascular screening and the elite athlete: advances, concepts, controversies, and a view of the future.

This article addresses programmatic cardiovascular screening and evaluation of the elite athlete at the intercollegiate, national team, professional, and Olympic levels. Although much of this content may apply to high-school and recreational sports at large, it is not specifically designed to address athletes participating in all sports activities.

Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: a 5-year experience.

BACKGROUND: Electrocardiographic screening of intercollegiate athletes is controversial because the costs and yield are not well defined. Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) have different criteria for screening, partly because the populations being screened are different. OBJECTIVE: The purpose of this study was to determine the cost and yield of a 5-year ECG screening program at a United States Division I college. METHODS: At the University of Virginia, all 1,473 competitive athletes over the course of 5 years were screened with history and physical and with ECGs using ESC guidelines with follow-up testing as dictated by clinical symptoms and ECG findings. RESULTS: History and physical alone uncovered five significant cardiac abnormalities. ECGs were abnormal in 275 (19%), resulting in 359 additional tests. Additional testing confirmed eight significant cardiac abnormalities that were not found by history and physical: 1 bicuspid aortic valve, 4 rapidly conducting accessory pathways, 1 long QT patient, 1 with frequent premature ventricular contractions and low ejection fraction, and 1 with frequent premature ventricular contractions but normal ejection fraction. No cases of hypertrophic cardiomyopathy were found. Total cost of the program was US $894,870. Cost of history and physical screening alone was $343,725 or $68,745 per finding. The marginal cost of adding ECG screening, including resulting tests and procedures. was US$551,145 or US$68,893 per additional finding. CONCLUSION: ECG screening of U.S. college athletes can uncover significant cardiac pathology not discovered by history and physical alone. Although ECG screening also results in many false positives resulting in additional tests, the overall cost per diagnosis of adding ECG screening is similar to that of history and physical screening alone.