What happened to Ntanga - the medical facts:

Ntanga died tragically on Tuesday night at the first soccer practice of the fall. He was 13 and many are asking what happened? Why did someone so young and fit loose consciousness and not recover?

Ntanga has experienced episodes of loss of consciousness before and in fact, has had 5 or 6 episodes while playing soccer over the last year. All of his events happened after strenuous exertion, usually on a hot day. Typically he developed lightheadedness, felt faint and collapsed to the ground, recovering spontaneously after several minutes. On one occasion he had some jerky movements of his arms and legs, raising the question of epileptic seizures. After the first episode he was taken to the emergency room by ambulance. All the tests on that visit were normal. He underwent extensive other medical investigations. He consulted with a pediatric cardiologist and had a number of cardiology tests including an ECG (electrical heart tracing), echocardiogram (heart ultrasound), a 3 week ambulatory heart monitor and a treadmill exercise test. All of these were also completely normal. He also consulted a neurologist and had a brain scan and EEG (looking for electrical epileptic activity). With all these negative tests and repeated episodes of loss of consciousness it was thought that he most likely had vasovagal syncope – recurring common faints. He was encouraged to hydrate well, and to sit or lie down if he felt lightheaded.

The event that occurred on Tuesday August 11th was similar to the previous episodes. During a reasonably intense scrimmage, he became light headed. His father, Edgar, saw him put his hands on his head and then sit on the ground. He went over to his son and then saw him loose consciousness and become unresponsive. His breathing became labored and he did not make the usual recovery after a few seconds. The trainer was called, an AED (automatic defibrillator) was fetched from the clubhouse and 2 UVA ER physicians rushed to his assistance. The rescue squad arrived after a few minutes. He had intensive resuscitation with chest compressions and a breathing tube was inserted. Emergency drugs were administered. Despite all of these efforts, he failed to respond and eventually he passed away.

He was taken to UVA and his parents consented to an autopsy the following day. The preliminary results are now available. At the autopsy it was found that he had an anomalous left main coronary artery. This is a rare syndrome in which one of the two coronary arteries (supply blood to the heart) arises from an unusual location on the aorta (the big blood vessel coming out of the heart). This artery then wraps around some of the main blood vessels (aorta and pulmonary artery) to reach the part of the heart to which it supplies blood. The aorta can squash the anomalous coronary during strenuous activity. This would then limit the blood supply to the heart and could cause a heart attack or abnormal life threatening rhythms.

This anomalous coronary artery was the most likely cause of Ntanga’s death.

Despite this information, there remains an element of uncertainty. The full results of the autopsy will only be available in 6 weeks. His failure to respond to such prompt and excellent resuscitation is not well understood. In fact his pulse recovered during the resuscitation but his consciousness and respiration never improved. We have however, found no other plausible explanation of these events and thus assume it was the anomalous coronary artery.

Could this have been diagnosed and treated and death prevented? Anomalous coronary arteries can be diagnosed on heart catheterization or CT scans. In some cases, symptomatic patients undergo open heart surgery to bypass this abnormal vessel. This is high risk and sometimes, controversial surgery. In Ntanga’s case, the left main coronary artery was seen on the echocardiogram after it tracked around the aorta to its normal position and was considered normal. The real abnormality was hidden from view. It was then considered unnecessary to do other investigations.

Unfortunately, this tragedy represents the limits of medical science and the resolution of advanced heart imaging techniques. There are very few diagnostic tests that are perfect at picking up abnormalities and this case is an example of the limitations.

It is our opinion that Ntanga received excellent medical attention and that the efforts to resuscitate him were prompt and of high caliber. We could not have done more to try to rescue him.

John Ferguson M.D. Aug 14th, 2009.