The rare heart defect that killed basketball star Pete Maravich might have been repaired by an operation like common bypass surgery if his complaints of intense shoulder and chest pain in the last six months of his life had led to a thorough examination, according to doctors who reviewed coroner's documents released Wednesday.
And while physicians who reviewed the 16-page file agreed the detailed coroner's findings are consistent with previous disclosures of the strange cause of the basketball star's death Jan. 5, several experts said they were still puzzled by how, under the circumstances, Maravich could have ever played basketball--let alone star for a decade in the National Basketball Assn.
Several doctors suggested that the highly unusual total absence of one of the major arteries to Maravich's heart may have obscured the possibility his heart tissue had also been damaged by any of a variety of factors.
They range from latent weakening resulting from years of excessive drinking--behavior to which Maravich himself alludes in a recently published biography--or an undiagnosed viral infection.
"This is a really bizarre case," said Dr. Frank Litvack, a cardiology diagnostic expert at Cedars-Sinai Medical Center, who reviewed the full documentary file. He said the heart defect may occur in only between 1 in 100,000 to 1 in 1 million patients.
Maravich was 40 when he died. He collapsed after playing in a pickup game at a Pasadena church and died shortly after paramedics rushed him to a local hospital.
Tests of Maravich's blood and stomach contents for the presence of alcohol and a wide variety of other drugs, including cocaine, were completely negative, the coroner's written report confirmed.
"Usually patients like this don't go on for 40 years. They don't make it that long," said Dr. Paul Thompson, a sudden death expert at Brown University in Rhode Island who reviewed the Maravich autopsy file Wednesday.
"The problem with the diagnosis," said Dr. Thomas Klitzner, a UCLA specialist in pediatric cardiology and the way heart rhythm disturbances lead to sudden death, "is how did he play basketball for all those years in the NBA?"
Litvack, who reviewed the full documentary file, said damage to Maravich's heart tissue "is not explained purely by the coronary anomaly."
He said, "It is difficult to know why he would have (the damage found in the heart muscle.) It could be anything from a previous viral infection to drinking."
The file, which comprises the official, written results of the autopsy and other post-mortem tests, confirms that Maravich completely lacked one of the major arteries supplying oxygen-rich blood to the tissue of his heart.
The documents also revealed for the first time that Maravich had complained of chest pain in the final six months of his life. Previous reports had indicated he also complained of intense pain in his right shoulder.
The combination of chest and shoulder pain, said doctors questioned by The Times, could have led to the ordering of a treadmill stress test on Maravich, in which the test subject walks on a treadmill while instruments monitor heart function.
Maravich's personal physician, Dr. William Mitchell, of Covington, La., did not respond to calls seeking reaction to the autopsy details.
Thompson said chest and shoulder pain in a 40-year-old man are always potential danger signs that should be taken as a possible warning of heart problems.
Thompson and Dr. Jeffrey Isner, a Tufts University specialist in heart disease processes who has reviewed the Maravich case with Los Angeles County Coroner's Office officials, agreed that the treadmill stress test could have produced results that would lead doctors to order additional tests that would have discovered the strange inherited anomaly in Maravich's heart.
The only procedure that could have definitively diagnosed Maravich is a procedure called cardiac catheterization in which a wire is introduced into the arteries while X-ray machinery, assisted by dye injected into the blood, projects pictures of the organs on a television screen. The catheterization procedure is commonly used to determine if bypass surgery is necessary.
Maravich's defect could probably have been repaired by an operation almost identical to common bypass surgery.
The entire blood supply to Maravich's heart had been supplied, the autopsy file indicated, by a narrow shunt-like vessel that ran circuitously across Maravich's heart from the right to left side.
The natural shunt was never able to supply adequate amounts of blood, resulting in gradual deterioration of the muscle in Maravich's heart, enlargement of the heart and development of fiber-like growths in the tissue, the coroner concluded.