Evaluation and management of anomalous origin of the right coronary artery in athletes: literature review

Abstract

The anomalous origin of the right coronary artery (AORCA) represents a rare congenital anatomical variation, yet one of significant clinical relevance, particularly due to its association with sudden cardiac death in young athletes. Fifteen articles published between 2020 and 2024 were analyzed, including case reports, clinical series, and narrative reviews, addressing epidemiological, pathophysiological, diagnostic, and therapeutic aspects of AORCA. The main findings indicate that although many patients remain asymptomatic, manifestations such as syncope, chest pain, and arrhythmias may occur, especially in the context of intense physical exercise. The interarterial course of the right coronary artery, located between the aorta and the pulmonary trunk, is considered the highest-risk variant. Therapeutic strategies range from clinical follow-up in asymptomatic cases to surgical intervention in symptomatic patients or those at high risk of a potentially fatal outcome. Management should be individualized according to clinical presentation, anatomical characteristics, and estimated risk of sudden death. Pre-participation evaluation of athletes is essential to prevent adverse complications. Despite being a rare condition, it should be considered in young athletes, with careful assessment through imaging tests such as coronary computed tomography angiography.