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Right Coronary Artery Originating from the Left: Do Not Miss the Diagnosis! Cardiol Res Pract 2018; 2018:1210791. [PMID: 29744224 PMCID: PMC5884397 DOI: 10.1155/2018/1210791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/05/2018] [Indexed: 12/05/2022] Open
Abstract
Objective Left circumflex (LCx) artery originating from the right coronary arterial (RCA) system has been reported as the most common form of anomalous origination of a coronary artery from the opposite sinus (ACAOS). However, some studies claim that RCA originating from the left coronary sinus (LCS) is the most frequent form. The aim of this study was to determine the most common type of ACAOS in a single center. Materials and Methods The database of the catheterization laboratory was retrospectively searched. All patients who were performed coronary angiography between 1999 and 2006 were included to registry. All examinations were carefully analyzed to determine the most frequent type of ACAOS. Results We detected ACAOS in 35 cases (16 RCA originating from the LCS, 13 LCx from the RCS or the RCA, and 6 others) out of 5165 coronary angiograms. The most common form was RCA originating from LCS. Moreover, we revealed that 5 cases with RCA originating from the LCS were previously misdiagnosed and not reported as a coronary anomaly. Conclusions RCA originating from the LCS was the most common form of ACAOS in our registry. The high change of misdiagnosis or underreporting of this anomaly could have biased the true prevalence.
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Driesen BW, Warmerdam EG, Sieswerda GJT, Schoof PH, Meijboom FJ, Haas F, Stella PR, Kraaijeveld AO, Evens FCM, Doevendans PAFM, Krings GJ, van Dijk APJ, Voskuil M. Anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), fractional flow reserve- and intravascular ultrasound-guided management in adult patients. Catheter Cardiovasc Interv 2018. [DOI: 10.1002/ccd.27578] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bart W. Driesen
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
- Department of Cardiology; Radboudumc Nijmegen; Nijmegen GA 6525 The Netherlands
| | - Evangeline G. Warmerdam
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Gert-Jan T. Sieswerda
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Paul H. Schoof
- Department of Pediatric Cardiothoracic Surgery, Division Children; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Folkert J. Meijboom
- Department of Cardiology, Division Heart and Lungs, and Department of Pediatric Cardiology; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Felix Haas
- Department of Pediatric Cardiothoracic Surgery, Division Children; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Pieter R. Stella
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Adriaan O. Kraaijeveld
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Fabiola C. M. Evens
- Department of Pediatric Cardiothoracic Surgery, Division Children; Wilhelmina Children's Hospital, University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Pieter A. F. M. Doevendans
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
| | - Gregor J. Krings
- Department of Pediatric Cardiology, Division Children; University Medical Center Utrecht; Utrecht EA 3584 The Netherlands
| | - Arie P. J. van Dijk
- Department of Cardiology; Radboudumc Nijmegen; Nijmegen GA 6525 The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, Division Heart and Lungs; University Medical Center Utrecht; Utrecht CX 3584 The Netherlands
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Glushko T, Seifert R, Brown F, Vigilance D, Iriarte B, Teytelboym OM. Transseptal course of anomalous left main coronary artery originating from single right coronary orifice presenting as unstable angina. Radiol Case Rep 2018; 13:549-554. [PMID: 29849856 PMCID: PMC5966622 DOI: 10.1016/j.radcr.2018.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/04/2018] [Indexed: 12/02/2022] Open
Abstract
Transseptal course of coronary artery has often been described as a benign entity; however, this report and literature analysis provides growing evidence of high risk of serious cardiovascular events in this anomaly. We present a case of unstable angina in a patient with anomalous common origin of left and right coronary arteries from a single coronary ostium at the right sinus of Valsalva, with subsequent transseptal course of the left main artery, review of relevant literature, and discussion of possible management options.
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Affiliation(s)
- Tetiana Glushko
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Richard Seifert
- Department of Cardiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Fraser Brown
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Deon Vigilance
- Department of Cardiothoracic Surgery, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Blanca Iriarte
- Department of Internal Medicine, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Oleg M Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
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Anomalous Coronary Arteries on Computer Tomography Angiography: a Pictorial Review. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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56
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Lee JH, Park JS. Successful percutaneous coronary intervention in the setting of an aberrant left coronary artery arising from the right coronary cusp in a patient with acute coronary syndrome: a case report. BMC Cardiovasc Disord 2017; 17:186. [PMID: 28697726 PMCID: PMC5505013 DOI: 10.1186/s12872-017-0621-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An aberrant origin of the left coronary artery (LCA) from the right coronary cusp (RCC) is an extremely rare congenital anomaly. We here report on successful percutaneous coronary intervention (PCI) in a patient presenting with acute coronary syndrome and an aberrant origin of the LCA from the RCC. CASE PRESENTATION A 50-year-old man presented at our emergency department with recurrent resting chest pain. Following unsuccessful attempts at visualizing the left coronary artery using Judkins left and Amplatz catheters, an aortogram using a pigtail catheter suggested anomalous left coronary artery origin and showed a significant occlusive lesion at proximal left anterior descending artery. A Judkins right 4 guiding catheter was placed around the left coronary ostium and exchanged for a Judkins left 3.5 guiding catheter after introducing a .014" coronary long wire into the left circumflex artery. With excellent angiographic visualization and guide support, a drug-eluting stent was then successfully implanted. Cardiac computed tomography (CT) demonstrated left coronary artery origin from right coronary cusp. CONCLUSION This report presents a case of LCA originating from the RCC accompanied with acute coronary syndrome that was treated with successful PCI.
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Affiliation(s)
- Jung-Hee Lee
- Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine, 3170, Hyeonchung-ro, Nam-gu, Daegu, Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine, 3170, Hyeonchung-ro, Nam-gu, Daegu, Korea.
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Cheezum MK, Liberthson RR, Shah NR, Villines TC, O'Gara PT, Landzberg MJ, Blankstein R. Anomalous Aortic Origin of a Coronary Artery From the Inappropriate Sinus of Valsalva. J Am Coll Cardiol 2017; 69:1592-1608. [PMID: 28335843 DOI: 10.1016/j.jacc.2017.01.031] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/05/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) from the inappropriate sinus of Valsalva is increasingly recognized by cardiac imaging. Although most AAOCA subtypes are benign, autopsy studies report an associated risk of sudden death with interarterial anomalous left coronary artery (ALCA) and anomalous right coronary artery (ARCA). Despite efforts to identify high-risk ALCA and ARCA patients who may benefit from surgical repair, debate remains regarding their classification, prevalence, risk stratification, and management. We comprehensively reviewed 77 studies reporting the prevalence of AAOCA among >1 million patients, and 20 studies examining outcomes of interarterial ALCA/ARCA patients. Observational data suggests that interarterial ALCA is rare (weighted prevalence = 0.03%; 95% confidence interval [CI]: 0.01% to 0.04%) compared with interarterial ARCA (weighted prevalence = 0.23%; 95% CI: 0.17% to 0.31%). Recognizing the challenges in managing these patients, we review cardiac tests used to examine AAOCA and knowledge gaps in management.
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Affiliation(s)
- Michael K Cheezum
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Cardiology Service, Fort Belvoir Community Hospital, Ft. Belvoir, Virginia.
| | - Richard R Liberthson
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nishant R Shah
- Lifespan Cardiovascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Brown University Alpert School of Medicine, Providence, Rhode Island
| | - Todd C Villines
- Department of Medicine, Cardiology Service, Walter Reed National Military Medical Center, Bethesda Maryland
| | - Patrick T O'Gara
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Ron Blankstein
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Infarto con elevación del ST en pacientes con origen anómalo de coronaria derecha en el seno de Valsalva izquierdo y trayecto interarterial. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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60
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Brothers JA, Frommelt MA, Jaquiss RD, Myerburg RJ, Fraser CD, Tweddell JS. Expert consensus guidelines: Anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg 2017; 153:1440-1457. [DOI: 10.1016/j.jtcvs.2016.06.066] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023]
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Gräni C, Buechel RR, Kaufmann PA, Kwong RY. Multimodality Imaging in Individuals With Anomalous Coronary Arteries. JACC Cardiovasc Imaging 2017; 10:471-481. [DOI: 10.1016/j.jcmg.2017.02.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/08/2017] [Accepted: 02/15/2017] [Indexed: 01/02/2023]
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Burchill LJ, Huang J, Tretter JT, Khan AM, Crean AM, Veldtman GR, Kaul S, Broberg CS. Noninvasive Imaging in Adult Congenital Heart Disease. Circ Res 2017; 120:995-1014. [DOI: 10.1161/circresaha.116.308983] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Multimodality cardiovascular imaging plays a central role in caring for patients with congenital heart disease (CHD). CHD clinicians and scientists are interested not only in cardiac morphology but also in the maladaptive ventricular responses and extracellular changes predisposing to adverse outcomes in this population. Expertise in the applications, strengths, and pitfalls of these cardiovascular imaging techniques as they relate to CHD is essential. The purpose of this article is to provide an overview of cardiovascular imaging in CHD. We focus on the role of 3 widely used noninvasive imaging techniques in CHD—echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography. Consideration is given to the common goals of cardiac imaging in CHD, including assessment of structural and residual heart disease before and after surgery, quantification of ventricular volume and function, stress imaging, shunt quantification, and tissue characterization. Extracardiac imaging is highlighted as an increasingly important aspect of CHD care.
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Affiliation(s)
- Luke J. Burchill
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Jennifer Huang
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Justin T. Tretter
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Abigail M. Khan
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Andrew M. Crean
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Gruschen R. Veldtman
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Sanjiv Kaul
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
| | - Craig S. Broberg
- From the Knight Cardiovascular Institute (L.J.B., A.M.K., S.K., C.S.B.), Doernbecher Children’s Hospital (J.H.), Oregon Health and Science University, Portland; The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (J.T.T., G.R.V.); Department of Cardiology, Heart Lung and Vascular Institute, University of Cincinnati Medical Center, OH (A.M.C.); Department of Cardiology, Cincinnati Children’s Hospital, OH (A.M.C.); Department of Cardiology (A.M.C.) and Joint Department of Medical
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Gräni C, Benz DC, Steffen DA, Clerc OF, Schmied C, Possner M, Vontobel J, Mikulicic F, Gebhard C, Pazhenkottil AP, Gaemperli O, Hurwitz S, Kaufmann PA, Buechel RR. Outcome in middle-aged individuals with anomalous origin of the coronary artery from the opposite sinus: a matched cohort study. Eur Heart J 2017; 38:2009-2016. [DOI: 10.1093/eurheartj/ehx046] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/24/2017] [Indexed: 01/09/2023] Open
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Port S. Anomalous coronary arteries: What we know and what we do not know. J Nucl Cardiol 2017; 24:235-238. [PMID: 26739477 DOI: 10.1007/s12350-015-0384-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Steven Port
- Aurora Cardiovascular Services, Milwaukee, WI, USA.
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65
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Cheezum MK, Ghoshhajra B, Bittencourt MS, Hulten EA, Bhatt A, Mousavi N, Shah NR, Valente AM, Rybicki FJ, Steigner M, Hainer J, MacGillivray T, Hoffmann U, Abbara S, Di Carli MF, DeFaria Yeh D, Landzberg M, Liberthson R, Blankstein R. Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA. Eur Heart J Cardiovasc Imaging 2017; 18:224-235. [PMID: 26848152 PMCID: PMC6279103 DOI: 10.1093/ehjci/jev323] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/15/2015] [Indexed: 12/16/2022] Open
Abstract
AIMS The impact of coronary computed tomographic angiography (CTA) on management of anomalous origin of the coronary artery arising from the opposite sinus (ACAOS) remains uncertain. We examined the prevalence, anatomical characterization, and outcomes of ACAOS patients undergoing CTA. METHODS AND RESULTS Among 5991 patients referred for CTA at two tertiary hospitals between January 2004 and June 2014, we identified 103 patients (1.7% prevalence) with 110 ACAOS vessels. Mean age was 52 years (range 5-83, 63% male), with 55% previously known ACAOS and 45% discovered on CTA. ACAOS subtypes included: 39% interarterial (n = 40 anomalous right coronary artery, n = 3 anomalous left coronary artery), 38% retroaortic, 15% subpulmonic, 5% prepulmonic, and 2% other. ACAOS patients were assessed for symptoms, ischaemic test results, revascularization, all-cause or cardiovascular (CV) death, and myocardial infarction. CTAs were reviewed for ACAOS course, take-off height and angle, length and severity of proximal narrowing, intramural course, and obstructive coronary artery disease (CAD). In follow-up (median 5.8 years), there were 20 surgical revascularizations and 3 CV deaths. After adjusting for obstructive CAD (n = 21/103, 20%), variables associated with ACAOS revascularization included the following: CV symptoms, proximal vessel narrowing ≥50%, length of narrowing >5.4 mm, and an interarterial course. CONCLUSION The prevalence of ACAOS on CTA was 1.7%, including 45% of cases discovered incidentally. CTA provided excellent characterization of ACAOS features associated with coronary revascularization, including the length and severity of proximal vessel narrowing.
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Affiliation(s)
- Michael K Cheezum
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Brian Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcio S Bittencourt
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
- Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil
| | - Edward A Hulten
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
- Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Ami Bhatt
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Negareh Mousavi
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Nishant R Shah
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Marie Valente
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Frank J Rybicki
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Steigner
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jon Hainer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas MacGillivray
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Suhny Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcelo F Di Carli
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Doreen DeFaria Yeh
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Landzberg
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Richard Liberthson
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
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Mosca RS, Phoon CKL. Anomalous Aortic Origin of a Coronary Artery Is Not Always a Surgical Disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 19:30-6. [PMID: 27060040 DOI: 10.1053/j.pcsu.2015.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/11/2022]
Abstract
Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has become a high-profile lesion as a result of its association with sudden cardiac death in otherwise young and healthy individuals. Despite our incomplete knowledge of its pathophysiology and natural history, surgical intervention is often recommended. Evidence now shows AAOCA to be relatively common, with lower than previously suspected rates of sudden cardiac death. Analysis of this information reveals that AAOCA is not always a surgical disease. Future multi-institutional studies will continue to define those subgroups best served by observation or surgery.
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Affiliation(s)
- Ralph S Mosca
- George E. Reed Professor of Cardiac Surgery Vice Chairman, Clinical Affairs, Chief, Division of Congenital Cardiac Surgery, NYU Langone Medical Center, New York, NY
| | - Colin K L Phoon
- Division of Pediatric Cardiology, NYU Langone Medical Center, New York, NY.
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Singhi AK, Bari EA, Banerjee S. Anomalous origin of right coronary artery causing myocardial ischemia in a young patient. Ann Pediatr Cardiol 2017; 10:212-214. [PMID: 28566835 PMCID: PMC5431039 DOI: 10.4103/apc.apc_151_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Anomalous right coronary artery from left coronary sinus can have dynamic narrowing and kinking causing symptoms of myocardial ischemia and sudden cardiac death. Surgical repair of the anomaly is required in the symptomatic patient because of risk of ischemia or ventricular arrhythmia. Asymptomatic incidentally diagnosed low-risk patients can be closely followed up with exercise restriction as per present guideline.
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Affiliation(s)
- Anil Kumar Singhi
- Department of Pediatric Cardiology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Ejaz Ahmad Bari
- Department of Radiology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Sunip Banerjee
- Department of Cardiology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
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ST-elevation Myocardial Infarction in Anomalous Origin of Right Coronary Artery From the Left Sinus of Valsalva and Interarterial Course. ACTA ACUST UNITED AC 2016; 70:596-598. [PMID: 27914872 DOI: 10.1016/j.rec.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/30/2016] [Indexed: 11/20/2022]
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69
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Paul AD, Avadhani R, Subramanyam K. Anomalous origins and branching patterns in coronary arteries – An angiographic prevalence study. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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70
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Lorber R, Srivastava S, Wilder TJ, McIntyre S, DeCampli WM, Williams WG, Frommelt PC, Parness IA, Blackstone EH, Jacobs ML, Mertens L, Brothers JA, Herlong JR. Anomalous Aortic Origin of Coronary Arteries in the Young: Echocardiographic Evaluation With Surgical Correlation. JACC Cardiovasc Imaging 2016; 8:1239-49. [PMID: 26563852 DOI: 10.1016/j.jcmg.2015.04.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to compare findings from institutional echocardiographic reports with imaging core laboratory (ICL) review of corresponding echocardiographic images and operative reports in 159 patients with anomalous aortic origin of a coronary artery (AAOCA). The study also sought to develop a "best practice" protocol for imaging and interpreting images in establishing the diagnosis of AAOCA. BACKGROUND AAOCA is associated with sudden death in the young. Underlying anatomic risk factors that can cause ischemia-related events include coronary arterial ostial stenosis, intramural course of the proximal coronary within the aortic wall, interarterial course, and potential compression between the great arteries. Consistent protocols for diagnosing and evaluating these features are lacking, potentially precluding the ability to risk stratify patients based on evidence and plan surgical strategy. METHODS For a prescribed set of anatomic AAOCA features, percentages of missing data in institutional echocardiographic reports were calculated. For each feature, agreement among institutional echocardiographic reports, ICL review of images, and surgical reports was evaluated using the weighted kappa statistic. An echocardiographic imaging protocol was developed heuristically to reduce differences between institutional reports and ICL review. RESULTS A total of 13%, 33%, and 62% of echocardiograms were missing images enabling diagnosis of intra-arterial course, proximal intramural course, and high ostial takeoff, respectively. There was poor agreement between institutional reports and ICL review for diagnosis of origin of coronary artery, interarterial course, intramural course, and acute angle takeoff (kappa = 0.74, 0.11, -0.03, 0.13, respectively). Surgical findings were also significantly different from those of reports, and to a lesser extent ICL reviews. The resulting protocol contains technical recommendations for imaging each of these features. CONCLUSIONS Poor agreement between institutional reports and ICL review for AAOCA suggests need for an imaging protocol to permit evidence-based risk stratification and surgical planning. Even then, delineation of echocardiographic details in AAOCA will remain imperfect.
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Affiliation(s)
- Richard Lorber
- Children's Hospital of San Antonio, Baylor College of Medicine, Houston, Texas
| | | | - Travis J Wilder
- Congenital Heart Surgeons' Society Data Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan McIntyre
- Congenital Heart Surgeons' Society Data Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - William M DeCampli
- Congenital Heart Surgeons' Society Data Center, Hospital for Sick Children, Toronto, Ontario, Canada; Arnold Palmer Hospital for Children, Orlando, Florida.
| | - William G Williams
- Congenital Heart Surgeons' Society Data Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ira A Parness
- Kravis Children's Hospital at Mount Sinai, New York, New York
| | - Eugene H Blackstone
- Children's Hospital of San Antonio, Baylor College of Medicine, Houston, Texas; Congenital Heart Surgeons' Society Data Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marshall L Jacobs
- Congenital Heart Surgeons' Society Data Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luc Mertens
- Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - J René Herlong
- Sanger Heart and Vascular Institute-Charlotte Pediatric Cardiology, Charlotte, North Carolina
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71
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Layser RB, Savage MP, Halpern EJ. Anomalous Coronary Arteries: Analysis of Clinical Outcome Based Upon Arterial Course and Surgical Intervention in an Adult Population. Acad Radiol 2016; 23:1015-23. [PMID: 27161207 DOI: 10.1016/j.acra.2016.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 01/04/2023]
Abstract
RATIONALE AND OBJECTIVES The study aimed to evaluate the association of a coronary interarterial course (IAC) with adverse outcomes in adults and to assess the benefit of coronary artery bypass grafting (CABG) in this population. MATERIALS AND METHODS A retrospective review identified 172 adults over 40 years of age with an anomalous coronary artery origin from the opposite coronary sinus, including 79 patients with an IAC. Hard outcomes (myocardial infarction or cardiac death) and soft outcomes (persistent angina) were evaluated, with a mean follow-up time of 5 years. RESULTS Although the frequency of coronary artery disease (CAD) was lower among patients with an IAC (43% vs 59%; P < 0.05), the frequency of CABG was higher among those with an IAC (21/79 = 26% vs 16/93 = 17%; P = 0.15). Hard outcomes were equally frequent among IAC patients (12/79 = 15%) compared to those without an IAC (16/93 = 17%) (P = 0.7), and among patients with a right IAC (11/68 = 16%) compared to those with a left IAC (1/11 = 9%) (P = 0.56). Among patients with an IAC, the frequency of hard outcomes was similar with CABG (4/21 = 19%) versus without CABG (8/59 = 14%) (P = 0.55); the frequency of soft events was also similar with CABG (9/21 = 43%) versus without CABG (18/59 = 31%) (P = 0.3). On multivariate analysis, the extent of coronary disease was the only significant predictor of hard or soft outcome (the presence of IAC, CABG, and left vs right IAC were not significant; P > 0.3). CONCLUSIONS The frequency of hard and soft outcomes among adult patients with anomalous coronary arteries is not significantly related to the presence of an IAC. No benefit was documented from the CABG treatment of an IAC in the absence of CAD.
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72
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Zanotti G, Gupta R, Reece TB, Campbell DN, Jaggers J, Babu A. Aortic Valve Sparing Root Replacement With Unroofing and Reconstruction of an Anomalous Right Coronary Artery. Ann Thorac Surg 2016; 101:1980-2. [DOI: 10.1016/j.athoracsur.2015.07.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 06/27/2015] [Accepted: 07/20/2015] [Indexed: 11/16/2022]
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Raimondi F, Bonnet D. Imaging of congenital anomalies of the coronary arteries. Diagn Interv Imaging 2016; 97:561-9. [PMID: 27132711 DOI: 10.1016/j.diii.2016.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
Congenital abnormalities of the coronary arteries are extremely variable and include anomalies of their origin (atresia, anomalies of origin from the aorta or from the pulmonary artery), the course of the epicardiac coronary branches (intramural, myocardial bridge) and distal connections (coronary-cardiac chamber fistulae). In pediatric practice, the diagnosis relies on ultrasound which should be supplemented by additional cardiac imaging in most cases. Multidetector CT is the most widely used imaging technique to identify abnormal courses and relationships with the greater vessels. In this paper, the important diagnostic and prognostic features in the interpretation of coronary imaging in pediatric practice is discussed.
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Affiliation(s)
- F Raimondi
- Pediatric cardiology-M3C, hôpital Necker-Enfants-Malades, AP-HP, université Paris-Descartes, Sorbonne Paris Cité, 149, rue de Sèvres, 75743 Paris cedex 15, France.
| | - D Bonnet
- Pediatric cardiology-M3C, hôpital Necker-Enfants-Malades, AP-HP, université Paris-Descartes, Sorbonne Paris Cité, 149, rue de Sèvres, 75743 Paris cedex 15, France
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74
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Bonnichsen C, Ammash N. Choosing Between MRI and CT Imaging in the Adult with Congenital Heart Disease. Curr Cardiol Rep 2016; 18:45. [DOI: 10.1007/s11886-016-0717-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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75
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Coronary arteries anomalous aortic origin on a computed tomography angiography population: prevalence, characteristics and clinical impact. Int J Cardiovasc Imaging 2016; 32:983-90. [DOI: 10.1007/s10554-016-0849-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/01/2016] [Indexed: 01/09/2023]
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Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2015; 9:475-92. [DOI: 10.1016/j.jcct.2015.07.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
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Sintek MA, Singh J, Billadello JJ. Dynamic Evaluation of Coronary Anomalies Originating from the Opposite Sinus of Valsalva (ACAOS). CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:47. [PMID: 26373642 DOI: 10.1007/s11936-015-0407-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OPINION STATEMENT Coronary anomalies originating from the opposite sinus of Valsalva (ACAOS) are a rare anomaly associated with sudden cardiac death. Dynamic, invasive evaluation using coronary angiography, intravascular ultrasound, and fractional flow reserve can more clearly identify important pathophysiologic variants and guide treatment. This dynamic evaluation can assist the clinician in the appropriate surgical and percutaneous treatment options and aid in patient counseling. Long-term outcomes data regarding treatment and prognosis is still lacking.
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Affiliation(s)
- Marc A Sintek
- Cardiovascular Division, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Jasvindar Singh
- Cardiovascular Division, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joseph J Billadello
- Cardiovascular Division, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
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Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:66-75. [PMID: 25678906 PMCID: PMC4308460 DOI: 10.11909/j.issn.1671-5411.2015.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/27/2014] [Accepted: 11/07/2014] [Indexed: 01/09/2023]
Abstract
Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.
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80
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Anomalous origin and course of left coronary artery-Cause of cardiac arrest in a young female athlete. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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81
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Mason SE, Lipshultz SE, Kaushal S, Fisher S. The implication of coronary artery malformations and congenital heart disease on cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2014. [DOI: 10.1016/j.ppedcard.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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82
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Valve-Sparing Aortic Root Replacement in the Presence of Coronary Anomalies. Ann Thorac Surg 2014; 98:1858-9. [DOI: 10.1016/j.athoracsur.2014.03.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/17/2014] [Accepted: 03/26/2014] [Indexed: 11/19/2022]
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83
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Abstract
Anomalous origin of a coronary artery from the aorta is a potentially serious anomaly that occurs in about 0.1-0.2% of the population. This percentage is small; however, it translates into about 4000 annual births with these anomalies. The clinical presentation of these anomalies is rare, and hence most are and will remain asymptomatic. The various anatomic anomalies are described, with anomalous origin of the left coronary artery that then passes between the aorta and pulmonary artery being the most serious of these anomalies. The pathophysiology resulting from these anomalies is described, as are methods for identifying those who require treatment; however, we still do not know the best methods of determining which patients need treatment.
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84
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Nasis A, Machado C, Cameron JD, Troupis JM, Meredith IT, Seneviratne SK. Anatomic characteristics and outcome of adults with coronary arteries arising from an anomalous location detected with coronary computed tomography angiography. Int J Cardiovasc Imaging 2014; 31:181-91. [PMID: 25218760 DOI: 10.1007/s10554-014-0535-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/06/2014] [Indexed: 11/28/2022]
Abstract
We sought to determine the anatomic characteristics of coronary arteries arising from an anomalous location (CAAL) detected on coronary computed tomography angiography (CTA) and assess the impact of high-risk anatomic characteristics on patient management and outcomes. We reviewed 9,774 consecutive CTA studies performed in adults between 2008-2013 and identified 114 with CAAL. CTA examinations were analysed to determine CAAL type, CAAL course (pre-pulmonary, interarterial, septal or retroaortic) and whether additional high-risk anatomic characteristics were present (luminal compression, intramural course, slit-like ostium and acute takeoff angle). Patients were contacted at mean 27.1-months to determine safety outcomes. The prevalence of CAAL was 1.14 % (114 of 9,974), with 36 (32 %) having anomalous right coronary artery from left coronary sinus, 71 (62 %) having anomalous left coronary artery from right coronary sinus and 7 (6 %) having a coronary artery arising outside coronary sinuses. Fifty-six patients (49 %) had ≥1 high-risk anatomic characteristic on CTA. Ten patients (9 %) underwent surgical intervention. Patients with high-risk anatomic features more frequently underwent functional testing (46 vs. 12 %, P = 0.01) and surgical intervention (14 vs. 3 %; P = 0.04) compared to patients without high-risk features. Patients undergoing surgery were more likely to have obstructive coronary disease on CTA than patients managed conservatively (50 vs. 13 %, P = 0.01). There was no cardiac death or ACS at follow-up (100 % complete). High-risk anatomic features on CTA in patients with CAAL more frequently lead to surgical management. Regardless of CAAL type, presence of high-risk anatomic characteristics or management strategy, the medium-term outcome of adults with CAAL is excellent.
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Affiliation(s)
- Arthur Nasis
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, 246 Clayton Road, Clayton, 3168, Australia,
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85
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Coronary Artery Anomalies: Current Recognition and Treatment Strategies. Update on Recent Progress. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0395-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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86
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Ripley DP, Saha A, Teis A, Uddin A, Bijsterveld P, Kidambi A, McDiarmid AK, Sivananthan M, Plein S, Pennell DJ, Greenwood JP. The distribution and prognosis of anomalous coronary arteries identified by cardiovascular magnetic resonance: 15 year experience from two tertiary centres. J Cardiovasc Magn Reson 2014; 16:34. [PMID: 24886614 PMCID: PMC4038832 DOI: 10.1186/1532-429x-16-34] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/17/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Aberrant coronary arteries represent a diverse group of congenital disorders. Post-mortem studies reveal a high risk of exercise-related sudden cardiac death in those with an anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS) with an inter-arterial course. There is little documentation of lifetime history and long-term follow-up of patients with coronary artery anomalies. METHODS Patients with anomalous coronary arteries undergoing cardiovascular magnetic resonance over a 15-year period were identified and classified by anatomy and course. Medical records were reviewed for major adverse cardiovascular events (MACE). Revascularisation or myocardial infarction counted only if occurring in the distribution of the anomalous artery. RESULTS Consecutive patients with coronary artery anomalies were retrospectively identified (n = 172). Median follow-up time was 4.3 years (IQR 2.5-7.8, maximum 15.6). 116 patients had ACAOS of which 64 (55%) had an inter-arterial course (IAC) and 52 (45%) did not. During follow up 110 ACAOS patients were alive, 5 died and 1 lost to follow-up.ACAOS patients experienced 58 MACE events (5 cardiovascular deaths, 5 PCI, 24 CABG and 24 had myocardial infarction). 47 MACE events occurred in ACAOS with IAC and 11 in those without (p < 0.0001), the statistical difference driven by surgical revascularisation and myocardial infarction. CONCLUSIONS In life, patients with an anomalous coronary artery originating from the opposite sinus of Valsalva taking an IAC have higher rates of both myocardial infarction and surgical revascularisation during long-term follow up, compared to those without IAC.
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Affiliation(s)
- David P Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Ansuman Saha
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Albert Teis
- NIHR Cardiovascular Biomedical Research Unit Royal Brompton Hospital, London, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Petra Bijsterveld
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Mohan Sivananthan
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit Royal Brompton Hospital, London, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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87
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Angelini P. What is in a name? The need for strict diagnostic criteria in computerized tomographic angiography of anomalous coronary artery originating from the opposite aortic sinus. Am J Cardiol 2013; 111:1680. [PMID: 23680522 DOI: 10.1016/j.amjcard.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
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