2022 Western Medical Research Conference

Anomalous Coronary Origin: The Challenge In Preventing Exercise-related Sudden Cardiac Death

The sudden cardiac death (SCD) of a young athlete is a catastrophic event, particularly in the absence of prodromal warning symptoms. Anomalous coronary origin (ACO) is a well-described cause of cardiac symptoms and SCD, but the diagnosis is usually missed by conventional non-invasive investigations designed to identify myocardial ischaemia. SCD is preventable by correction of the anomaly. A tragic case of a promising young athlete who had underlying ACO and who presented with prodromal symptoms with multiple "negative" investigations is described to highlight the typical clinical features and outline the difficulties encountered in accurate premortem diagnosis.

'Grateful To Be Alive': Dominic Jackson Returns To St. Xavier Track After Heart Surgery

Dominic Jackson was a sophomore at St. Xavier High School in the fall of 2021, starring on the cross-country team and preparing to play junior varsity basketball in the winter but he would experience chest pain during some of his workouts.

"I don't really know why I decided to say that I felt pain in my chest sometimes because it didn't happen extremely often. It was really just when I worked out really hard and I was like, 'Everybody feels this type of pain. It's really not anything that serious.'" Jackson said.

© Geoff Blankenship for The Enquirer Dominic Jackson takes the baton from Gavin Pelzel as St. Xavier placed second in the Division I 4-x-400 meter relay at the OHSAA Southwest District Track and Field Championships, Mason, Ohio, May 19, 2023.

After he mentioned this chest pain at a September 2021 appointment, his doctor ordered an electrocardiogram. When the results were inconclusive, Jackson underwent an echocardiogram so doctors could study his heart's structure and blood flow. That ultrasound revealed an Anomalous Aortic Origin of the Right Coronary Artery (AAORCA).

Start the day smarter. Get all the news you need in your inbox each morning.

Four for Fort Mitchell: Beechwood outlasts Highlands to win 9th Region championship

More: Greater Cincinnati high school sports scores, May 22-28

What is AAOCA?

According to Boston Children's Hospital, Anomalous Aortic Origin of a Coronary Artery "is a rare congenital heart condition in which one (in rare cases, both) of the coronary arteries arises from the wrong aortic sinus." Symptoms include chest pain, dizziness, extreme fatigue, fainting and rapid heartbeat. It occurs in one to five of every 1,000 people, about 0.5% of the population.

In Jackson's case, the right coronary artery, which typically originates from the right side of the aorta, wrapped around the back of his aorta and originated closer to the left coronary artery. As the rest of his heart pumped blood, it pinched the coronary artery, which is what caused his chest pain.

There are several treatment options for AAOCA. Sedentary people may continue to live their normal life while monitoring their symptoms. In active individuals, an "unroofing" surgery is recommended to relocate the artery and provide better blood flow to the heart muscle. If left untreated, it can result in sudden cardiac arrest.

A heavy decision

Jackson knew the seriousness of his diagnosis, but it didn't carry a lot of weight initially since he was still able to play sports.

His parents, Jenny and Derrick, waited a few days before telling Dominic that his doctors had unanimously recommended surgery. He immediately wanted to have the surgery so he could go back to playing sports, but Jenny and Derrick weighed the options of living with the condition versus the operation table.

"That's me as the adult trying to protect my son from having to go through this super traumatic thing," Derrick said. 

© Provided by Jenny Jackson St. Xavier's Dominic Jackson receives coaching instructions from cross country coach Mike Dehring at the GCL championship meet on Oct. 15, 2022.

But that's not who Dominic is. He started playing basketball when he was 6 years old and started running in the sixth grade. He was eager to return to the hardwood and the track.

After successfully undergoing surgery on Feb. 21, 2022, Jackson couldn't wait to return to everyday life. Jenny and Derrick supported him as he grew stronger every day.

"We were constantly emailing the doctors, 'Can he do this? Is he allowed to do that?'" Jenny said.

Lessons and virtues

Jackson kept the Bible passage Luke 1:37, which reads, "for nothing will be impossible for God," in his Instagram biography. He recently changed it to Romans 8:25, which reads, "But if we hope for what we do not have, we wait for it patiently."

"Even before the surgery, just talking to God and praying just gave me a sense of comfort that everything would be fine," Jackson said.

Patience has been key for Jackson. His surgery, originally scheduled for Jan. 18, 2022, had to be rescheduled for Feb. 21 when he tested positive for COVID-19. His unroofing surgery was successful but he had an extended stay in the hospital because of a collapsed right lung and a lingering air pocket in his chest.

© Provided by Jenny Jackson The first step in Dominic Jackson's recovery was walking the hallways at Cincinnati Children's Hospital, pictured here with a nurse and his dad, Derrick.

Upon returning home, he would get exhausted by just taking a shower or walking to the mailbox. He couldn't use his upper body until his chest had healed. Laughing hurt. Jackson wondered how he could return to running 12 miles at a time or playing basketball for hours on end. But he set goals for himself every day, focusing on taking baby steps.

"It was really just getting 1% better every day, which was really hard," Jackson said.

It started with daily walks. Dominic and Jenny went to Mount St. Joseph to use the indoor track, walking one minute longer than the last each day. His recovery progressed rapidly, aided by his athletic background.

On June 13, 2022, he was cleared to return to athletic activity with no restrictions. Jackson thought about how he was going to return to his previous fitness after doing nothing but walking the previous four months.

"I knew that I wasn't at the level that I was before. So I knew that I would have to work really hard to get back to where I am right now," Jackson said.

Over the summer, he began playing basketball and went to cross-country camp to prepare for his junior season. When he returned to the cross country team, he would start at a slower pace than the rest of the team and gradually increase until he had caught up to his teammates.

Maybe the biggest step in his recovery was learning to care for his mental health. He could talk to his teammates about what they were each going through, but he started to see a sports psychologist to help him clear mental hurdles.

Combining all these factors taught Jackson the biggest lesson of all.

"I'm way stronger than I thought I was as a man and as an athlete," Jackson said. "I'm just really grateful to be alive every day."

A web of support

Throughout his diagnosis and recovery, Jackson's friends, teammates and coaches had his back at every turn. They came over to his house to play video games to keep him company. But an unlikely source of comfort came from Mason High School, which has a rivalry with the Bombers in track and cross country.

"Those are guys that we go head-to-head with. They're the same as us. They're all pretty legit runners," Jackson said. "Seeing them reach out to me as a rival was kind of cool."

© Geoff Blankenship for The Enquirer St. Xavier's Dominic Jackson ran a 400-meter personal best time of 50.29 seconds at Mason on May 19, 2023.

That support made it even more significant when Jackson set his 400-meter personal best at last week's Division I district meet at Mason. He also ran on the 4-x-400 relay team that qualified for next weekend's state championships.

Cards, phone calls and emails came from his family, friends, neighbors and even Derrick's grade school basketball team.

"I do think he was quite a bit of a source of inspiration for people to just see how well he responded," Jenny said.

Giving back © Provided by Jenny Jackson Jenny, Dominic and Derrick Jackson at the 2023 Cincinnati Heart Mini-Marathon.

Jackson participated in the 2023 Cincinnati Heart Mini-Marathon with several teammates. They ran the 5K and believe that Jackson was the first "heart survivor" finisher. The Jackson family and their friends formed Team Jack(son) of Hearts to raise money for the American Heart Association.

"Participating is a way to support and give back to causes and programs that allowed us to have the research to figure this out," Jenny said.

Jackson said he is back to 100% health from a physical and mental perspective. This fall, he hopes to return to the top seven on the cross-country team with all the mileage he has built up so far.

This article originally appeared on Cincinnati Enquirer: 'Grateful to be alive': Dominic Jackson returns to St. Xavier track after heart surgery

PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE

PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE

PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE

ContentsPrevious ConditionNext Condition

2d-1. Patent ductus arteriosus. (Legend.)

A. The heart is slightly enlarged, the main pulmonary artery convex, and the aortic arch prominent above the MPA. There are increased pulmonary vascular markings.

B. Right anterior oblique view demonstrates the esophagus to be indented by a large left aortic arch in addition to posterior displacement by the dilated left atrium.

Patent Ductus Arteriosus (PDA)

Persistent patent ductus arteriosus occurs in 1 in 2500 to 1 in 5000 live births and represents between 9-12% of all congenital heart defects. There is a 2:1 female to male ratio.

Embryology: the ductus arteriosus originates from the distal portion of one of the sixth paired aortic arches and enables communication between the pulmonary artery and the descending aorta. In an infant with a normal left aortic arch, the ductus originates from the distal left sixth aortic arch and connects the main pulmonary artery to the left descending aorta distal to the origin of the left subclavian artery. With a right aortic arch the ductus normally still arises from the distal left sixth arch along with a remnant of the left dorsal aorta (Kommerell's diverticulum), either as an isolated structure or in association with an anomalous left subclavian artery; in both these cases the ductus or its ligamentum passes behind the trachea and esophagus and creates a vascular ring. Rarely in infants with a right aortic arch, the ductus arises from the distal right sixth aortic arch and connects the right pulmonary artery to the right descending aorta distal to the origin of the right subclavian.

Associations: Infants of prematurity, patients exposed to hypoxemia, birth at high altitudes, female sex and exposure to rubella particularly in the first 4 weeks of pregnancy are all associated with an increased incidence.

Physical examination: The classical findings are diagnostic. The pulses are bounding. The blood pressure has a wide pulse presssure. The apex beat may be displaced. There is a LV impulse. The second heart sound is loud and widely split with a "slap-sail" quality. The murmur is characteristically continuous or machinery like in quality. The diastolic component may disappear as one move down the sternum, particularly in smaller infants.

Complications: These include congestive cardiac failure, bacterial endocarditis, aneurysmal dilation of the ductus and potentially the development of pulmonary hypertension.

Differential diagnosis: This includes the innocent venous hum (obliterated with pressure over the inferior neck), aortopulmonary window, truncus arteriosus, absent pulmonary valve syndrome, VSD with aortic regurgitation, ruptured sinus of Valsalva with fistula, systemic and pulmonary arteriovenous fistula, aortopulmonary collaterals, coronary artery fistula and peripheral branch pulmonary stenosis.

---