**4.4 Clinical and laboratory features of aberrant coronary arteries**

Often, the first presentation of most patients with aberrant coronary arteries is SCD with exercise. A few patients may present with symptoms of angina or syncope following exercise [22]. Some patients may be detected during echocardiograms performed for some other reason. Routine physical examination is completely normal. Patients with complaints of angina or syncope following exercise should be evaluated

#### **Figure 13.**

*A short-axis view of the aorta demonstrating aberrant left coronary artery from the right sinus of Valsalva, traversing between the aorta (AO) and pulmonary artery (PA). (reproduced from reference [16]).*

#### **Figure 14.**

*The short-axis views of the aorta (Ao) demonstrate aberrant right coronary artery (RCA) from the left sinus of Valsalva by two-dimensional (A and B) and color flow (CF) (C) imaging. The intramural (IM) course of the right coronary artery is shown in 'B'.*

#### **Figure 15.**

*The short-axis views of the aorta (Ao) demonstrate aberrant right coronary artery (RCA) from the left sinus of Valsalva by two-dimensional (A) and color flow (B) imaging. Color flow (CF) at the origin of RCA (B) and intramural (IM) course of the RCA (A and B) are shown. PA. Pulmonary artery.*

by a cardiologist. Stress testing, while routinely used for complaints of this nature, a regular stress test may not yield abnormal results in subjects with aberrant CAs particularly if the stress test is sub-maximal [16, 17]. If the stress test with maximal activity is performed, it may precipitate a coronary event or even sudden death. Instead, the author recommends echocardiographic studies, focusing on imaging of proximal CAs [16]. Reliable echocardiographic screening methods to identify aberrant CAs (**Figure 17**) have been described [23, 24] and may be used. However, normalcy (**Figures 10**–**12**) of the CAs or aberrancy (**Figures 13**–**16**) should be documented by direct visualization of the CAs by transthoracic echocardiographic studies. With the

*Pre-Sports Participation Cardiac Screening Evaluation – A Review DOI: http://dx.doi.org/10.5772/intechopen.102942*

#### **Figure 16.**

*The short-axis views of the aorta (Ao) demonstrate aberrant right coronary artery (RCA) from the left sinus of Valsalva by two-dimensional (A) and color flow (B) imaging. Color flow acceleration (FA) at the origin of RCA (B) may suggest stenosis at the origin of RCA. The intramural (IM) course of the RCA (A and B) is seen. PA. Pulmonary artery.*

#### **Figure 17.**

*Parasternal long-axis two-dimensional echo images of the left atrium (LA), left ventricle (LV) and aorta (AO) in a normal child are shown in A. A similar view of the heart in a child with an aberrant coronary artery (CA) is shown in B which demonstrated a cross-sectional image of the CA in the anterior wall of the AO (arrow in B). RV, right ventricle. Modified from Jureidini SB, Marino CJ, Singh GK, Balfour IC, Rao PS. J Am Society of Echocard 2003; 16: 756–763 [23].*

current state-of-the-art echocardiographic equipment, echo studies are the primary tools of investigation. If transthoracic echocardiographic images are not clear, especially in adolescents and adults with poor acoustic windows, other studies such as transesophageal echocardiography (TEE), computed tomography (CT) scan, or angiography may have to be performed to demonstrate the CA anatomy. Surgical re-implantation of the aberrant CAs along with enlarging the coronary ostium and un-roofing the intramural portion of the CA, as deemed appropriate, can be safely performed, and subsequent to recovery from surgery, participation in the full athletic activity is feasible.
