Why sports cardiologists are encouraged by Bronny James' diagnosis

A little more than a month after Bronny James collapsed and lost consciousness during a USC basketball workout, his family has broken its silence about what may have caused his sudden cardiac arrest.

The James family revealed new details but stopped short of offering an exact diagnosis on Friday in a statement expressing optimism that Bronny will make a full recovery and “return to basketball in the very near future.”

The probable cause of Bronny’s cardiac arrest is “an anatomically and functionally significant congenital heart defect,” according to the statement from a family spokesperson. The condition “can and will be treated,” the statement said.

Sports cardiologists told Yahoo Sports that congenital heart defects are structural heart issues that develop during pregnancy and are present at birth. The cardiologists came away encouraged by the James family describing Bronny's condition as treatable and interpreted that as evidence it may be repairable via surgery.

"That's obviously very promising news," said Meagan Wasfy, a sports cardiologist and echocardiographer at the Massachusetts General Hospital. "You don't want sudden cardiac arrest to start with, but when there is a procedure or remedy to reduce risk if the athlete returns to sport, that's an update that creates some optimism for the future."

There are “a variety” of congenital abnormalities that can lead to increased risk of sudden cardiac arrest and match the James family's description, according to Lili Barouch, director of sports cardiology at Johns Hopkins University School of Medicine. She said "it's hard to say exactly what this is" unless the family releases more information, but she also noted that "it's really encouraging to hear that they found something and that it’s fixable.”

Jonathan Drezner, director of the University of Washington’s center for sports cardiology, mentioned an anomalous coronary artery as one of the most common congenital abnormalities that fits this description.

An anomalous coronary artery is the medical term for a developmental abnormality of the artery that supplies oxygen-rich blood to the heart. Shareef O’Neal, the eldest son of Shaquille O’Neal, underwent open-heart surgery in 2018 to repair an anomalous coronary artery and returned the following year to begin his college basketball career at UCLA.

If Bronny's diagnosis is also fixable by surgery, Drezner says he expects "a full recovery."

While the exact cause of Bronny’s cardiac arrest is still a mystery publicly, sports cardiologists say that the new details make it possible to eliminate certain explanations. For example, Barouch says it’s now clear this wasn’t a side effect of a severe electrolyte abnormality, a viral infection or drugs or medication.

“There was a lot of chatter that this was related to COVID or the COVID vaccine,” Barouch said. “This effectively rules that sort of thing out.”

Bronny, the elder son of Los Angeles Lakers superstar LeBron James, went into cardiac arrest during a July 24 workout and left USC’s campus in the back of an ambulance. He was transported to Cedars-Sinai Medical Center, where he was briefly treated in the intensive care unit before returning home three days later.

A statement from Bronny’s cardiologist credited the “swift and effective response by USC athletics’ medical staff” for the highly touted basketball prospect avoiding brain or organ damage from oxygen deprivation. Bronny quickly resumed most normal activities, from going out to a posh Santa Monica Italian restaurant with his family, to attending a Dodgers game alongside LeBron, to accompanying Drake on stage at the start of the rapper’s Los Angeles concert.

And yet cardiologists cautioned that Bronny’s speedy recovery offered no assurance that he’d ever play high-level basketball again. The underlying cause and severity of Bronny’s cardiac arrest and his tolerance for risk would determine whether the McDonald’s All-American could continue his quest to join his illustrious father in the NBA.

Now, at last, Bronny has some answers — and it seems he’ll be the second USC basketball player in two years to try to return to the court under these circumstances. Vince Iwuchukwu went into cardiac arrest during a workout last July and played for the Trojans six months later.

To Wasfy, Bronny's story underscores the important of schools providing CPR training, placing AEDs where medical staff can access them easily and rehearsing emergency action plans. Wasfy said that the most common congenital heart defects don't show up when athletes take simple screening tests.

"While we can screen athletes for conditions that might predispose them to sudden cardiac arrest, it's equally important to be prepared for when these events occur," Wasfy said. "It's easy to see how important that was in this case given the way it progressed. It has allowed this athlete to have a good outcome and even consider a return to sport."