A strange, natural heart defect--so rare no statistics exist on how often it occurs--took the life of basketball star Pete Maravich last week, a coroner's report concluded Monday.
Maravich, 40, died of deterioration of the tissues in his heart because he was born without one of the two artery systems that supply the heart with blood.
The finding stunned cardiologists and other experts in sudden death in young athletes since the nearly unheard of condition is usually assumed to preclude strenuous activities. It usually kills its victims before they are 20.
"How could he play competitive sports? Well, obviously he did." observed Dr. Ronald McKenzie, a specialist in sports cardiology at the National Athletic Health Institute at Inglewood's Centinela Hospital Medical Center.
Dr. Frank Litvack, associate director of the Cedars-Sinai Medical Center heart testing laboratory, said that a doctor would naturally assume that athletic activity would be almost inconceivable if a person with Maravich's condition survived to his 20s or 30s. Litvack said the condition is so uncommon it is not even mentioned in most cardiology texts.
"You're dealing here with the most rare of the rare (defects)," Litvack said.
Dr. Thomas Bassler, a specialist in the study of heart disease in runners, characterized the case as "very, very unusual."
Maravich, the autopsy found, had no left coronary artery complex, one of the two systems of pencil-thick arteries that nourish the heart muscle with a continuous supply of richly oxygenated blood. The coronary arteries are the vessels on which bypass surgery is performed after the coronaries become clogged with fatty plaques that impair blood flow.
The coroner's autopsy found no evidence of serious plaque formation in Maravich, who had been a vegetarian in the years before he died.
When the coronary arteries malfunction in a normal person with both the right and left artery systems, symptoms such as angina pectoris occur and sudden death can sometimes result. Both coronary artery systems are important to maintaining cardiac health, but the left coronary artery system is the more important of the two.
Litvack said the largest study of defects such as the one Maravich had included only 43 patients, 34 of whom died before they turned 20--many of them people who dropped dead, as Maravich did, after engaging in vigorous exercise. Interestingly, Litvack and other experts said, the condition can often be undetectable even if a suspected victim is subjected to a treadmill stress test, in which the subject walks on a treadmill while electronic equipment monitors his heart function.
"Until people die, nobody will know they have this," Litvack said. "We don't know how many people there are who may be walking around with it."
Litvack said that perhaps the most unusual aspect of the Maravich case was the fact that he could participate in competitive athletics at all, let alone excel. Maravich established a collegiate basketball scoring record that still stands, averaging 44.2 points per game at Louisiana State University between 1967 and 1970.
His scoring total of 3,667 points also set a National Collegiate Athletic Assn. record. In a 10-year National Basketball Assn. career, Maravich played with the Atlanta Hawks, New Orleans and Utah Jazz and Boston Celtics. He was a two-time all-star and led the NBA in scoring in 1977.
Maravich dropped dead last Tuesday after participating in a pickup basketball game at a Pasadena church. A preliminary coroner's report released last week found the death was caused by heart disease, but the specific type was not identified pending microscopic examination of tissue samples.
Monday, however, the autopsy finding ruled that the total lack of a left coronary artery system gradually took a toll on the muscle tissue of Maravich's heart. Over time, the heart accumulated a quantity of fiber-like tissue, which led to a deterioration of the heart muscle in a condition called cardiomyopathy, in which the heart is unnaturally enlarged and weakened. Dr. Paul Thompson, a sudden death expert at Brown University in Rhode Island, said his reaction to the Maravich finding was one of near disbelief. "This (type of episode) is characteristic of the 16-year-old who collapses during a football game," Thompson said. "But for a guy to go 10 years in the NBA and have a congenital anomaly like that is, to say the least, very unusual.
"How could a guy like that run up and down the court for 20 years?"
Thompson contended that the cardiomyopathy could potentially have killed Maravich without the heart defect playing an immediate role, but he said the situation was apparently so strange the precise factor that triggered the instant of death in Maravich may never be clearly understood.
Bassler and other experts said the timing of Maravich's sudden death may have been related to the undetected heart defect. Litvack said people who have the rare defect often drop dead after exertion because their cardiovascular systems are unable to compensate for abrupt, dramatic changes in blood pressure that come with exercise and at the sudden conclusion of exercise.
The syndrome can result in a sudden change in the rhythm of the heart.
In such patients--if they can be identified--a so-called "warm-down," in which exercise is tapered off instead of suddenly stopped, can prevent the sudden, catastrophic change in blood pressure that can trigger a full cardiac arrest. Maravich apparently went into full arrest--a condition in which the heart discontinues its natural pumping sequence--when he collapsed at the church seconds after he told other players on the court that he felt "great."
"These things usually show up before the age of 40," McKenzie said. "In his situation, his blood supply was so compromised it left him an exceedingly vulnerable individual. Even minor changes (in blood pressure) could have had major consequences."
"What is safe to say is that this is an extremely rare anomaly," Litvack said. "What is surprising, considering the fact that he was such a vigorous athlete, is that it never manifested itself before and that he did survive until he was 40."