sudden cardiac death in children

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  • 1. Coarctation of the Aorta
    • postoperative hypertension noted beyond the 10th postoperative yr:
  • -- alive and well and normotensive
  • 70% at 10 yrs
  • 65% at 15 yrs
  • 20% at 25 yrs.
  • arm leg gradient with exercise average is 80 mm Hg.

2. SUDDEN DEATH in YOUNG ATHLETES Maron, et al, Circ 1980 3. Clinical Findings

  • asymptomatic21/29
  • syncope3/29
  • presyncope1/29
  • chest pain2/29
  • mild fatigue2/29

4. Circumstances of Death

  • death during or after severe exertion: 22/29
  • death occurred during mild exertion: 2/29
  • death occurred during sedentary activity: 5/29

5. Causes of Sudden Death 29 Probable CV Disease 6 5 1 Idiopathic Concentrichypertrophy (no fiber disarray) Hypoplastic coronaries 1 No CV disease 22 Unequivocal CV dis. 2 Ruptured aorta 3 Atherosclero. CA 3 ALCAPA 14 HOCM** 6. Magnitude of the Problem

  • excluding trauma, cardiac death is the most frequent cause of sports related death.
  • 5/100,000 have a condition which predisposes them to sudden death.
  • 1/200,000 athletes per yr have sudden death
  • ~12 high school ath. die/yr in U.S.

7. Types of Sports

  • basketball33%
  • football20%
  • running16%
  • swimming4.8%
  • wrestling3.8%
  • volleyball2.9%
  • tennis2.9%
  • baseball2.9%
  • GOLF50% have mitral abnormalities

21. Coarctation of the Aorta

  • Associated abnormalities:
  • -- intracranial aneurysms
  • -- late aortic dissection
  • -- intramural coronary artery disease

22. Coarctation of the Aorta Aortic aneurysms

  • With dacron onlay patches
  • -- 38% incidence of aneurysms
  • Aortic balloon angioplasty
  • -- incidence of aneurysms unknown
  • native vs recoarc. For recoarctation,
  • balloon is procedure of choice

23. Coarctation of the Aorta

  • Surgical results; aim for gradient < 10
  • 30-40% have recurrent gradient when surgery done at less than 1yr.
  • Significant late mortality-
  • --10-20% have resting hypertension
  • This is directly related to age at surgery.Exercise testing will provock gradient.