1
|
Tan L, Heath K, Byard RW. Hidden Coronary Artery Ostium and Sudden Death. Pediatr Dev Pathol 2024; 27:275-277. [PMID: 38221672 DOI: 10.1177/10935266231221710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
A 1-week-old girl died suddenly and unexpectedly. At autopsy the major finding was of a right dominant coronary artery circulation with an inapparent left coronary artery ostium. After careful examination, an anomalous origin of the left coronary artery was found with the ostium located in the non-coronary cusp immediately adjacent to the commissure of the non- and left coronary cusps. The ostium was of small caliber with an obliquely oriented artery (<45°) with no ostial ridges. The artery coursed anteriorly past the left coronary cusp between the aorta and the left atrial appendage to then follow its usual course inferiorly along the anterior aspect of the left ventricle. The reminder of the autopsy was unremarkable. Death was, therefore, attributed to an anomalous and hypoplastic left coronary artery (and ostium) with an acute angle of take-off. Tracing coronary arteries in the very young may be technically difficult due to their small size, thus identifying the location of ostia is important. This may be difficult when the ostium was located close to a commissure.
Collapse
Affiliation(s)
- Luzern Tan
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
| | - Karen Heath
- Forensic Science SA, Adelaide, SA, Australia
| | - Roger W Byard
- The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia
- Forensic Science SA, Adelaide, SA, Australia
| |
Collapse
|
2
|
Gräni C, Bigler MR, Kwong RY. Noninvasive Multimodality Imaging for the Assessment of Anomalous Coronary Artery. Curr Cardiol Rep 2023; 25:1233-1246. [PMID: 37851270 DOI: 10.1007/s11886-023-01948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary anomaly with the potential to cause myocardial ischemia and adverse cardiac events. The presence of AAOCA anatomy itself does not necessarily implicate a need for revascularization. Therefore, the purpose of this review is to assess how noninvasive comprehensive anatomic- and physiologic evaluation may guide patient management. RECENT FINDINGS The assessment of AAOCA includes an accurate description of the anomalous origin/vessel course including anatomical high-risk features such as a slit-like ostium, proximal narrowing, elliptic vessel shape, acute take-off angle, intramural course, and possible concomitant coronary atherosclerosis and hemodynamics. Various cardiac imaging modalities offer unique advantages and capabilities in visualizing these anatomical and functional aspects of AAOCA. This review explored the role of noninvasive multimodality imaging in the characterization of AAOCA by highlighting the strengths, limitations, and potential applications of the current different cardiac imaging methods, with a focus on the pathophysiology of myocardial ischemia and stress testing protocols.
Collapse
Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marius R Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| |
Collapse
|
3
|
Formato GM, Agnifili ML, Arzuffi L, Rosato A, Ceserani V, Zuniga Olaya KG, Secchi F, Deamici M, Conti M, Auricchio F, Bedogni F, Frigiola A, Lo Rito M. Morphological Changes of Anomalous Coronary Arteries From the Aorta During the Cardiac Cycle Assessed by IVUS in Resting Conditions. Circ Cardiovasc Interv 2023; 16:e012636. [PMID: 37417226 PMCID: PMC10348625 DOI: 10.1161/circinterventions.122.012636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Anomalous aortic origin of coronary artery (AAOCA) with intramural segment is associated with risk of sudden cardiac death, probably related to a compressive mechanism exerted by the aorta. However, the intramural compression occurrence and magnitude during the cardiac cycle remain unknown. We hypothesized that (1) in end diastole, the intramural segment is narrower, more elliptic, and has greater resistance than extramural segment; (2) the intramural segment experiences a further compression in systole; and (3) morphometry and its systolic changes vary within different lumen cross-sections of the intramural segment. METHODS Phasic changes of lumen cross-sectional coronary area, roundness (minimum/maximum lumen diameter), and hemodynamic resistance (Poiseuille law for noncircular sections) were derived from intravascular ultrasound pullbacks at rest for the ostial, distal intramural, and extramural segments. Data were obtained for 35 AAOCA (n=23 with intramural tract) after retrospective image-based gating and manual lumen segmentation. Differences between systolic and end-diastolic phases in each section, between sections of the same coronary, and between AAOCA with and without intramural tract were assessed by nonparametric statistical tests. RESULTS In end diastole, both the ostial and distal intramural sections were more elliptical (P<0.001) than the reference extramural section and the correspondent sections in AAOCA without intramural segment. In systole, AAOCA with intramural segment showed a flattening at the ostium (-6.76% [10.82%]; P=0.024) and a flattening (-5.36% [16.56%]; P=0.011), a narrowing (-4.62% [11.38%]; P=0.020), and a resistance increase (15.61% [30.07%]; P=0.012) at the distal intramural section. No-intramural sections did not show morphological changes during the entire cardiac cycle. CONCLUSIONS AAOCA with intramural segment has pathological segment-specific dynamic compression mainly in the systole under resting conditions. Studying AAOCA behavior with intravascular ultrasound during the cardiac cycle may help to evaluate and quantify the severity of the narrowing.
Collapse
Affiliation(s)
| | - Mauro Luca Agnifili
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Luca Arzuffi
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Antonio Rosato
- 3D and Computer Simulation Laboratory (G.M.F., A.R.), University of Pavia, Italy
| | - Valentina Ceserani
- IRCCS Policlinico San Donato, Milan, Italy. Department of Civil Engineering and Architecture, University of Pavia, Italy (V.C., M.C., F.A.)
| | | | - Francesco Secchi
- Department of Radiology (F.S.), University of Pavia, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Miriam Deamici
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Michele Conti
- IRCCS Policlinico San Donato, Milan, Italy. Department of Civil Engineering and Architecture, University of Pavia, Italy (V.C., M.C., F.A.)
| | - Ferdinando Auricchio
- IRCCS Policlinico San Donato, Milan, Italy. Department of Civil Engineering and Architecture, University of Pavia, Italy (V.C., M.C., F.A.)
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery (K.G.Z.O., A.F., M.L.R.), University of Pavia, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery (K.G.Z.O., A.F., M.L.R.), University of Pavia, Italy
| |
Collapse
|
4
|
Fiorentini C, Leone O, Bronzetti G, Pascali JP, Graziosi M, Pelotti S, Fais P. Sudden cardiac death related to left coronary artery anomalies including hypoplasia and anomalous origin with retro-aortic course. Leg Med (Tokyo) 2023; 61:102186. [PMID: 36563565 DOI: 10.1016/j.legalmed.2022.102186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Congenital anomalies of the coronary arteries are a rare condition with an incidence of 0.3-1.3% in the general population. Clinically, sometimes these anomalies increase the risk of myocardial ischemia, which can present with a wide spectrum of symptoms, from angina to sudden cardiac death (SCD). This case report is about the SCD of an 8-year-old male, in apparent good health, during a football training. Although basic life support maneuvers were performed timely from bystanders and medical staff, the automated external defibrillator (AED) was not used. Autopsy revealed multiple left coronary artery (LCA) anomalies: origin from a separate ostium in the right sinus of Valsalva, slit-like shape of the ostium, acute angle take-off of the LCA from the aorta, retro-aortic course and focal coronary hypoplasia of some branches of the LCA. Microscopic examination revealed diffuse ischemic consequences at a different stage of tissue repair and mild multifocal lymphocytic infiltration. No other significant elements were detected at post-mortem examination. We discuss the forensic evaluation about the cause and the manner of death, considering also the modality of the resuscitation attempts and the claimed malpractice, as often occurs in case of sudden unexpected death in young athletes.
Collapse
Affiliation(s)
- Clara Fiorentini
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Ornella Leone
- Cardiovascular Pathology Unit, Division of Pathology, IRCCS S. Orsola Hospital and University of Bologna, Bologna, Italy
| | - Gabriele Bronzetti
- Paediatric Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS S. Orsola Hospital and University of Bologna, Bologna, Italy
| | - Jennifer Paola Pascali
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
| | - Maddalena Graziosi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS S. Orsola Hospital and University of Bologna, Bologna, Italy
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Paolo Fais
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| |
Collapse
|
5
|
Geerlings-Batt J, Gupta A, Sun Z. Investigation of the Relationship between Right Coronary Artery-Aorta Angle and Coronary Artery Disease and Associated Risk Factors. J Clin Med 2023; 12:1051. [PMID: 36769698 PMCID: PMC9917625 DOI: 10.3390/jcm12031051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
At the level of the left coronary artery tree, there is evidence showing an association between bifurcation angle and coronary artery disease (CAD), and this motivated us to explore similar associations at the level of the right coronary artery (RCA). The purpose of this study was to determine whether there is a relationship between RCA-aorta angle and CAD and age, sex, body mass index, smoking status, hypertension, and high blood cholesterol. The coronary computed tomography angiography datasets and CAD risk factor checklists of 250 patients were retrospectively reviewed, with RCA-aorta angles measured via multiplanar reformation images. Independent t-tests were used to compare mean RCA-aorta angle measurements between groups, correlations between continuous variables were assessed using Pearson and Spearman correlations, and a general linear model was used to adjust for potentially confounding variables. Coronary angle measurements were conducted by two independent assessors with very strong intraclass correlation (r=0.999, p<0.001). A significantly smaller mean RCA-aorta angle was observed in the CAD group (79.07 ± 24.88°) compared to the normal group (92.08 ± 19.51°, p=0.001), in smokers (76.63 ± 22.94°) compared to non-smokers (85.25 ± 23.84°, p=0.016), and a narrow RCA-aorta angle was negatively correlated with BMI (r=-0.174, p=0.010). This study suggests a relationship between narrow RCA-aorta angles and CAD, smoking, and increasing BMI.
Collapse
Affiliation(s)
- Jade Geerlings-Batt
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia
| | - Ashu Gupta
- Medical Imaging Department, Fiona Stanley Hospital, Perth, WA 6150, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, WA 6845, Australia
| |
Collapse
|
6
|
Albano GD, Scalzo G, Malta G, De Lisi G, Argo A, Maresi E, Zerbo S. Juvenile sudden cardiac death due to congenital coronary ostial valve-like ridges: A case report and literature review. Med Leg J 2023:258172221145108. [PMID: 36694996 DOI: 10.1177/00258172221145108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Coronary artery anomalies are a heterogeneous group of congenital disorders affecting the coronary pattern with a characteristic (origin, number, number of hosts, course, etc.). They are rarely found in the population. We report the case of a 21-year-old male who died from sudden cardiac death caused by an isolated coronary ostial obstruction, secondary to a rare anomaly, the presence of a valve-like ridge consisting of a small fold in the Valsalva aortic sinus. The study provides a brief literature review on the pathophysiology, diagnosis, and clinical and medico-legal issues in coronary artery anomaly cases that may be helpful in forensic practice when dealing with sudden cardiac death in young people and highlights key points for further research and public health measures.
Collapse
Affiliation(s)
- Giuseppe D Albano
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Giovanni Scalzo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Ginevra Malta
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Giovanni De Lisi
- Patology Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Antonina Argo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Emiliano Maresi
- Patology Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| | - Stefania Zerbo
- Medico-legal Unit, University Hospital "Giaccone", PROMISE Department, University of Palermo, Italy
| |
Collapse
|
7
|
Guseh JS, Parakh A, Chen YLE, Sundt TM, Fitzsimons MG, Stathatos N, Harris C. Case 40-2022: A 38-Year-Old Man with Exertional Chest Discomfort. N Engl J Med 2022; 387:2450-2460. [PMID: 36577103 DOI: 10.1056/nejmcpc2211360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Sawalla Guseh
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Anushri Parakh
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Yen-Lin E Chen
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Thoralf M Sundt
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Michael G Fitzsimons
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Nikolaos Stathatos
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Cynthia Harris
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| |
Collapse
|
8
|
Unusual intramural course in an anomalous left coronary artery from the opposite coronary sinus. Cardiol Young 2022; 32:1848-1850. [PMID: 35225208 DOI: 10.1017/s1047951122000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a case of a patient with an anomalous left coronary artery originating from the opposite coronary sinus with evidence of intramural course at the level of the septal commissure and no slit-like deformation of the coronary ostium, acute take-off, or proximal vessel narrowing. According to previous publications, patients with anomalous coronary artery and intramural segments identified at surgery had coronary CT findings of acute take-off angle or proximal vessel narrowing; slit-like orifice; and elliptical cross-sectional shape. Although further investigation is required, we suggest that the intramural course may not be ruled out based on the absence of slit-like ostium, acute take-off, or proximal vessel narrowing.
Collapse
|
9
|
Cocco N, Madonna R, Cammalleri V, Cocco G, De Stefano D, Ricciardi D, Grigioni F, Ussia GP. Percutaneous treatment of a CTO in an anomalous right coronary artery: A rupture paved the way for new insights. Front Cardiovasc Med 2022; 9:916616. [PMID: 35966553 PMCID: PMC9372292 DOI: 10.3389/fcvm.2022.916616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
An anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus, with an interarterial course, has been associated with an increased risk of myocardial ischemia and sudden death. As the exact pathophysiology of AAOCA is not well understood, the clinical management is also not well defined. With increased use of non-invasive imaging, the diagnosis of AAOCA is increasing and the association of anomalous origin and atherosclerotic disease is becoming a more important topic. We report a rare case of AAOCA chronic total occlusion (CTO). A 40-year-old Caucasian man was referred for invasive coronary angiography (ICA) due to typical chest pain and positive myocardial scintigraphy. ICA demonstrated CTO of an anomalous right coronary artery (ARCA) originating from the left side of the ascending aorta with an interarterial course. There was no lesion in the left coronary artery. During the procedure, unexpected rupture of the coronary artery occurred after dilatation with a small balloon at low pressure. The complication in this case was handled with good procedural final result but was an occasion for a food for thought. Coronary artery perforations are rare but life-threatening procedural complications that are usually caused by predisposing anatomical and procedural factors. We issue a warning on the risk of complications during complex percutaneous coronary intervention of these arteries, and we reconsidered the pathophysiology of the anomaly in a way that could change the approach to the disease. Based on this complication, we hypothesized that the wall of the artery could be fragile due to histopathological alterations, which could have a role in the pathophysiology of coronary malignancy. Future autopsy studies should be focused on the analysis of the arterial wall of the patient affected by sudden death with this anomaly.
Collapse
Affiliation(s)
- Nino Cocco
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rosalinda Madonna
- Cardiology Division, Department of Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, Azienda Ospedaliero Universitaria Pisana Ospedale di Cisanello, Pisa, Italy
| | - Valeria Cammalleri
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G D'Annunzio, Chieti, Italy
| | - Domenico De Stefano
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Danilo Ricciardi
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Grigioni
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
10
|
Ogunleye OO, Ajibola O, Cheema M, Oke B, Sperling J. Co-occurrence of Anomalous Right Coronary Artery Origin and Subaortic Membrane in an Adult Male. Cureus 2022; 14:e27110. [PMID: 36000108 PMCID: PMC9391662 DOI: 10.7759/cureus.27110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
|
11
|
Zheng S, Kassem KM, Ikram S, Ganzel BL, Ghafghazi S, Kalra D. Dual Left Main Coronary Arteries With Ischemia and Coronary Steal. JACC Case Rep 2022; 4:764-769. [PMID: 35818592 PMCID: PMC9270633 DOI: 10.1016/j.jaccas.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/06/2022]
Abstract
A 59-year-old man had angina and an abnormal perfusion scan. Work-up revealed 2 left main coronary arteries: the anomalous artery originated from the right coronary cusp and took an aberrant interventricular septal course; the other artery was atretic. He underwent surgical unroofing, with resolution of symptoms. (Level of Difficulty: Intermediate.)
Collapse
|
12
|
Rizzo S, De Gaspari M, Frescura C, Padalino M, Thiene G, Basso C. Sudden Death and Coronary Artery Anomalies. Front Cardiovasc Med 2021; 8:636589. [PMID: 33869302 PMCID: PMC8044928 DOI: 10.3389/fcvm.2021.636589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
Congenital coronary artery anomalies (CAA) include a wide spectrum of malformations present at birth with various clinical manifestations and degrees of severity. Patients may be asymptomatic, and CAA may be an incidental finding during cardiac imaging or at autopsy. However, in other cases, ischemia-related signs and symptoms, leading to an increased risk of sudden cardiac death (SCD), often as first presentation may occur. In this chapter, we discuss the normal anatomy of the coronary arteries (CA) and the pathology of CAA at risk of SCD, including our experience with victims of SCD among the young population (age <40 years) and among athletes.
Collapse
Affiliation(s)
- Stefania Rizzo
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Carla Frescura
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
13
|
Bigler MR, Ashraf A, Seiler C, Praz F, Ueki Y, Windecker S, Kadner A, Räber L, Gräni C. Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence. Front Cardiovasc Med 2021; 7:591326. [PMID: 33553251 PMCID: PMC7859106 DOI: 10.3389/fcvm.2020.591326] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022] Open
Abstract
Coronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). The interarterial variants (with the anomalous vessel situated between the great arteries) are historically called "malignant," based on an anticipated higher risk for myocardial ischemia and sudden cardiac death (SCD), especially affecting young patients during strenuous physical activity. However, the interarterial course itself may not be the predominant cause of ischemia, but rather represents a surrogate for other ischemia-associated anatomical high-risk features. As the exact pathophysiology of ACAOS is not well-understood, there is a lack of evidence-based guidelines addressing optimal diagnostic work-up, downstream testing, sports counseling, and therapeutic options in patients with ACAOS. Therefore, treating physicians are often left with uncertainty regarding the clinical management of affected patients. This review focuses on the pathophysiologic consequences of ACAOS on myocardial ischemia and discusses the concept of the interplay between fixed and dynamic coronary stenosis. Further, we discuss the advantages and limitations of the different diagnostic modalities and give an outlook by highlighting the gaps of knowledge in the assessment of such anomalies.
Collapse
Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Afreed Ashraf
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Centre for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
14
|
Das D, Acharya D, Mahanta D, Singh S, Das T, Pramanik S. Anomalous origin of the right coronary artery from the left coronary sinus with medusa head left coronaries: Plethora of left coronary circulation with paucity of right one. Res Cardiovasc Med 2021. [DOI: 10.4103/rcm.rcm_42_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Tso J, Turner CG, Kim JH. A Hidden Threat: Anomalous Aortic Origins of the Coronary Arteries in Athletes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22. [PMID: 34177246 DOI: 10.1007/s11936-020-00859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review Anomalous aortic origins of the coronary arteries (AAOCA) are a primary cause of sudden cardiac death in athletes. This review will detail the epidemiology, pathophysiology, and risk stratification of AAOCA, while also highlighting return-to-play considerations for athletes. Recent Findings Sport pre-participation cardiovascular screening methods lack sensitivity and specificity in the identification of AAOCA. For the symptomatic athlete, clinicians must maintain a heightened clinical suspicion for AAOCA in order to proceed with appropriate cardiac imaging and functional assessments. Anomalous origin of the left coronary artery with an interarterial course is considered high-risk and requires sport restriction until surgical correction. In contrast, risks associated with anomalous origin of the right coronary artery are controversial, thus management and sports eligibility decisions may incorporate principles of shared-decision making. Summary Management options for athletes with AAOCA are complex, requiring a comprehensive clinical evaluation. While advances in multimodality cardiovascular imaging and physiologic functional assessments have improved AAOCA risk stratification, best practice treatment strategies for some AAOCA subtypes remain uncertain. As such, clinical management and sport eligibility decisions require an individualized approach. Future prospective data will guide optimization of treatment strategies for athletes with AAOCA.
Collapse
Affiliation(s)
- Jason Tso
- Division of Cardiology, Emory Clinical Cardiology Research Institute, Atlanta, GA
| | - Casey G Turner
- Division of Cardiology, Emory Clinical Cardiology Research Institute, Atlanta, GA
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiology Research Institute, Atlanta, GA
| |
Collapse
|
16
|
Diao KY, Zhao Q, Gao Y, Shi K, Ma M, Xu HY, Guo YK, Yang ZG. Prognostic value of dual-source computed tomography (DSCT) angiography characteristics in anomalous coronary artery from the opposite sinus (ACAOS) patients: a large-scale retrospective study. BMC Cardiovasc Disord 2020; 20:25. [PMID: 31952479 PMCID: PMC6966895 DOI: 10.1186/s12872-019-01285-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/27/2019] [Indexed: 02/08/2023] Open
Abstract
Background Most reported cases of right anomalous coronary artery from the opposite sinus (R-ACAOS) have benign clinical outcomes. However, patients with left ACAOS (L-ACAOS) and some of the patients with R-ACAOS are more at risk for arrhythmias and sudden cardiac death, which remains a major concern. Here we report the prevalence and anatomical features of ACAOS patients. Moreover, we explore the high-risk morphological signs and evaluate their mid-term prognostic value in R-ACAOS patients without surgical intervention. Methods Data from coronary computed tomography angiography (CTA) of 30,593 patients, pertaining to a single center over 5 consecutive years, were retrospectively analyzed. The image analysis included stenosis severity ranking and high-risk anatomy evaluation, based on the commercially available image post-processing software OsirX. Patients with R-ACAOS and without evidence of coronary atherosclerosis (CAD) were followed-up, with recording of the cardiovascular clinical events. Cox regression analysis was performed to identify the potential anatomical risk factors of cardiovascular clinical events for non-CAD R-ACAOS patients, using R project. Results The prevalence of ACAOS in the study population was 0.69% (211/30593). Significant differences were found between patients with mild (< 50%) and severe (> 50%) stenosis, in terms of height-to-weight ratio (HW ratio), take-off angle, and proximal stenosis length. A total of 54 cardiovascular clinical events were observed among 108 non-CAD R-ACAOS patients and an average follow-up of 27.8 ± 18.7 months. Among those patients’ anatomical features, stenosis severity was the main risk factor for cardiovascular clinical events during the mid-term follow-up, with a risk ratio of 4.14 (95% CI: 1.78 to 9.63, P < 0.001). Conclusions Among patients referred to coronary CTA, the overall incidence of ACAOS was 0.69%. For patients with R-ACAOS, severe stenosis was the independent risk factor of adverse clinical events in the mid-term follow-up, and positive clinical intervention might be needed to help them avoid the malignant clinical events.
Collapse
Affiliation(s)
- Kai-Yue Diao
- Department of Radiology, State Key Laboratory of Biotherapy West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, China
| | - Qin Zhao
- Department of Radiology, State Key Laboratory of Biotherapy West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, China
| | - Yue Gao
- Department of Radiology, State Key Laboratory of Biotherapy West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, China
| | - Ke Shi
- Department of Radiology, State Key Laboratory of Biotherapy West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, China
| | - Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hua-Yan Xu
- Department of Radiology, State Key Laboratory of Biotherapy West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China.
| | - Zhi-Gang Yang
- Department of Radiology, State Key Laboratory of Biotherapy West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, China.
| |
Collapse
|
17
|
Bjerrum OW, Siersma V, Hasselbalch HC, Lind B, Andersen CL. Association of the blood eosinophil count with end-organ symptoms. Ann Med Surg (Lond) 2019; 45:11-18. [PMID: 31360453 PMCID: PMC6637252 DOI: 10.1016/j.amsu.2019.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Eosinophilia may cause organ dysfunction, but an exact relation between eosinophil blood counts and adverse outcomes has not been described. The aim of the study is to associate in one model both normal and increased blood eosinophil counts to the subsequent development of common conditions in internal medicine, in which eosinophil granulocytes may play a role for the symptoms. Methods From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 359,950 individuals with at least one differential cell count (DIFF) during 2000–2007. From these, one DIFF was randomly chosen. From the Danish National Patient Register we ascertained organ damage, within four years following the DIFF. Using multivariable logistic regression, odds ratios were calculated and adjusted for previous eosinophilia, sex, age, year, month, CRP and comorbid conditions. Results Risks for skin- and respiratory disease were increased from above the median eosinophil count of 0.16 × 109/l and reached a plateau around 1.0 × 109/l. Furthermore, risks of most outcomes also increased when the eosinophil count approached zero. Conclusions The observed U-shaped association with a plateau of risks around 1 × 109/l indicates that the risk for symptoms due to eosinophilia do not increase proportionate at higher counts. This study demonstrates for the first time that there is indeed an increased risk below median count of 0.16 × 109/l for an increased risk for the same manifestations. Clinically, it means that a normal or even low count of eosinophils do not rule out a risk for organ affection by eosinophils, and may contribute to explain, why patients may have normal eosinophil counts in e.g. asthma or allergy and still have symptoms from the lungs and skin, most likely explained by the extravasation of eosinophils. Blood eosinophilia may cause end-organ symptoms. An exact relation between eosinophil count and outcome has not been demonstrated. Eosinophil numbers correlate to organ damage even below the definition of eosinophilia. This association is U-shaped between organ manifestations and eosinophil count in blood. A plateau of risks is observed around 1 × 109/l.
Collapse
Affiliation(s)
- Ole Weis Bjerrum
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Hematology, Odense University Hospital, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | | | - Bent Lind
- Department of Clinical Biochemistry, Hvidovre University Hospital, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.,Department of Hematology, Roskilde University Hospital, Denmark
| |
Collapse
|
18
|
Automated Curved and Multiplanar Reformation for Screening of the Proximal Coronary Arteries in MR Angiography. J Imaging 2018. [DOI: 10.3390/jimaging4110124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Congenital anomalies of the coronary ostia can lead to sudden death. A screening solution would be useful to prevent adverse outcomes for the affected individuals. To be considered for integration into clinical routine, such a procedure must meet strict constraints in terms of invasiveness, time and user interaction. Imaging must be fast and seamlessly integrable into the clinical process. Non-contrast enhanced coronary magnetic resonance angiography (MRA) is well suited for this. Furthermore, planar reformations proved effective to reduce the acquired volumetric datasets to 2D images. These usually require time consuming user interaction, though. To fulfill the aforementioned challenges, we present a fully automated solution for imaging and reformatting of the proximal coronary arteries which enables rapid screening of these. The proposed pipeline consists of: (I) highly accelerated single breath-hold MRA data acquisition, (II) coronary ostia detection and vessel centerline extraction, and (III) curved planar reformation of the proximal coronary arteries, as well as multiplanar reformation of the coronary ostia. The procedure proved robust and effective in ten volunteer data sets. Imaging of the proximal coronary arteries took 24 ± 5 s and was successful within one breath-hold for all patients. The extracted centerlines achieve an overlap of 0.76 ± 0.18 compared to the reference standard and the average distance of the centerline points from the spherical surface for reformation was 1.1 ± 0.51 mm. The promising results encourage further experiments on patient data, particularly in coronary ostia anomaly screening.
Collapse
|
19
|
Ganga KP, Shaw M, Sharma A, Jagia P. Rare origin of left main coronary artery from non-coronary sinus with aortic coarctation. BMJ Case Rep 2018; 2018:bcr-2018-226732. [PMID: 30333202 DOI: 10.1136/bcr-2018-226732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Anomalous origin of left main coronary artery from non-coronary sinus (LCANCS) is an extremely rare anomaly. Aortic coarctation in association with LCANCS has not been previously described in literature.
Collapse
Affiliation(s)
- Kartik P Ganga
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
20
|
Sabharwal N, Saxena A, Toreli A, Meghrajani V, Malik B, Shani J. Anomalous Aortic Origin of Coronary Arteries from the Opposite Sinus: A Case Report. Cureus 2018; 10:e3092. [PMID: 30333944 PMCID: PMC6172140 DOI: 10.7759/cureus.3092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Anomalous aortic origin of coronary arteries from the opposite sinus (AAOCA) is a rare finding which, when discovered, raises questions regarding its approach and management. Modern imaging techniques can help us to identify certain anatomical features of the anomalous coronary arteries to further classify them as benign or malignant anomalies. We present a case of a 64-year-old male who had an incidental finding of AAOCA with the left anterior descending artery arising from the right coronary cusp from an ostium anterior to the one that gave rise to both the left circumflex artery and right coronary artery (RCA). The patient was managed with a percutaneous coronary intervention for an obstructive disease of the RCA and was discharged with regular follow-ups.
Collapse
Affiliation(s)
| | - Abhinav Saxena
- Department of Cardiology, Maimonides Medical Center, New York, USA
| | - Aleksandre Toreli
- Department of Cardiology, SUNY Downstate Medical Center, Brooklyn, USA
| | - Vineet Meghrajani
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Bilal Malik
- Department of Cardiology, Maimonides Medical Center, Brooklyn, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, USA
| |
Collapse
|
21
|
Formato GM, Lo Rito M, Auricchio F, Frigiola A, Conti M. Aortic expansion induces lumen narrrowing in anomalous coronary arteries: a parametric structural finite element analysis. J Biomech Eng 2018; 140:2694849. [PMID: 30098160 DOI: 10.1115/1.4040941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Indexed: 01/05/2023]
Abstract
Anomalous aortic origin of coronary arteries (AAOCA) is a congenital disease that can lead to cardiac ischemia during intense physical activity. Although AAOCA is responsible for sudden cardiac death (SCD) among young athletes and soldiers, the mechanisms underlying the coronary occlusion during physical effort still have to be clarified. The present study investigates the correlation between geometric features of the anomaly and coronary lumen narrowing under aortic root dilatations. Idealized parametric computer-aided designed (CAD) models of the aortic root with anomalous and normal coronary are created and static finite element (FE) simulations of increasing aortic root expansions are carried out. Different coronary take-off angles and intramural penetrations are investigated to assess their role on coronary lumen narrowing. Results show that increasing aortic and coronary pressures lead to lumen expansions in normal coronaries, particularly in the proximal tract, while the expansion of anomalous coronary is impaired especially at the ostium. Concerning the geometric features of the anomaly, acute take-off angles cause elongated coronary ostia, with an eccentricity increasing with aortic expansion; the impact of intramural penetration of coronary on its luminal narrowing is limited. The present study provides a proof of concept of the biomechanical reasons underlying the lumen narrowing in AAOCA during aortic expansion, promoting the role of computational simulations as a tool to assess the mechanisms of this pathology.
Collapse
Affiliation(s)
- Giovanni Maria Formato
- University of Pavia, Dept. of Civil Engineering and Architecture (DICAr), Pavia, Italy, 27100
| | - Mauro Lo Rito
- IRCCS Policlinico San Donato, Dept. of Congenital Cardiac Surgery, San Donato Milanese, Italy, 20097
| | - Ferdinando Auricchio
- University of Pavia, Dept. of Civil Engineering and Architecture (DICAr), Pavia, Italy, 27100
| | - Alessandro Frigiola
- IRCCS Policlinico San Donato, Dept. of Congenital Cardiac Surgery, San Donato Milanese, Italy, 20097
| | - Michele Conti
- University of Pavia, Dept. of Civil Engineering and Architecture (DICAr), Pavia, Italy, 27100
| |
Collapse
|
22
|
Das A, Joseph A, Jolly N, Kalra DK. Stress test to STEMI: Utility of coronary CTA in the diagnosis and management of anomalous right coronary artery from the left coronary cusp. Echocardiography 2017; 34:1519-1523. [DOI: 10.1111/echo.13700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anshuman Das
- Department of Medicine; Division of Cardiology; Section of Interventional Cardiology; Rush University Medical Center; Chicago IL USA
| | - Ajay Joseph
- Department of Medicine; Division of Cardiology; Section of Interventional Cardiology; Rush University Medical Center; Chicago IL USA
| | - Neeraj Jolly
- Department of Medicine; Division of Cardiology; Section of Interventional Cardiology; Rush University Medical Center; Chicago IL USA
| | - Dinesh K. Kalra
- Advanced Cardiac Imaging; Rush University Medical Center; Chicago IL USA
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Rosseel L, Bonnier H, Sonck J. Anomalous right coronary artery in a middle-aged patient: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e5508. [PMID: 27930539 PMCID: PMC5266011 DOI: 10.1097/md.0000000000005508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND An anomalous right coronary artery originating from the left sinus of Valsalva is a rare, but often incidental, finding in middle-aged to elderly people. Prevalence is difficult to define, as well as determining potential harmful hemodynamic consequences. Moreover, the optimal treatment remains debatable. CASE SUMMARY The authors present a case of a middle-aged patient diagnosed with an anomalous right coronary artery causing ischemia, who was treated surgically. CONCLUSION By reviewing literature, the authors conclude that choice of treatment depends on age, symptoms, and certain anatomic features of this anomaly. However, there are no randomized trials available in this field.
Collapse
|
25
|
De Bartolo D, De Luca E, Arena V, Ausania F, Buja LM, Ricci P. Bifid cardiac apex and high take off: an unusual association in a case of sudden death. Cardiovasc Pathol 2016; 25:512-514. [DOI: 10.1016/j.carpath.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 01/17/2023] Open
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Anomalous origin of RCA from left coronary sinus presenting as PSVT and recurrent acute coronary syndromes. Indian Heart J 2016; 68:208-10. [PMID: 27133342 PMCID: PMC4867971 DOI: 10.1016/j.ihj.2016.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/24/2016] [Indexed: 11/23/2022] Open
Abstract
Anomalous origin of the right coronary artery from the left sinus of Valsalva and coursing between the aorta and pulmonary artery is a rare congenital abnormality representing less than 3% of the congenital coronary anomalies. Patients can present with myocardial ischemia, arrhythmias, or sudden cardiac death (SCD). This diagnosis should be suspected in young patients without risk factors for coronary artery disease and the diagnosis can be confirmed easily by 64-slice MDCT angiography. Surgery is generally recommended in symptomatic patients whereas conservative management in asymptomatic patients. Incidence of SCD is rare after the age of 35 years and hence conservative treatment may be advised in asymptomatic patients over the age of 35 years.
Collapse
|
28
|
Kim SS, Ko SM, Choi SI, Choi BH, Stillman AE. Sudden cardiac death from structural heart diseases in adults: imaging findings with cardiovascular computed tomography and magnetic resonance. Int J Cardiovasc Imaging 2016; 32 Suppl 1:21-43. [PMID: 27139460 DOI: 10.1007/s10554-016-0891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 02/07/2023]
Abstract
Sudden cardiac death (SCD) is defined as the unexpected natural death from a cardiac cause within an hour of the onset of symptoms in the absence of any other cause. Although such a rapid course of death is mainly attributed to a cardiac arrhythmia, identification of structural heart disease by cardiovascular computed tomography (CCT) and cardiovascular magnetic resonance (CMR) imaging is important to predict the long-term risk of SCD. In adults, SCD most commonly results from coronary artery diseases, coronary artery anomalies, inherited cardiomyopathies, valvular heart diseases, myocarditis, and aortic dissection with coronary artery involvement or acute aortic regurgitation. This review describes the CCT and CMR findings of structural heart diseases related to SCD, which are essential for radiologists to diagnose or predict.
Collapse
Affiliation(s)
- Song Soo Kim
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Bo Hwa Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Arthur E Stillman
- Department of Radiology, Division of Cardiothoracic Imaging, Emory University Hospital, Atlanta, GA, USA
| |
Collapse
|
29
|
Forte E, Inglese M, Infante T, Schiano C, Napoli C, Soricelli A, Salvatore M, Tedeschi C. Anomalous left main coronary artery detected by CT angiography. Surg Radiol Anat 2016; 38:987-90. [DOI: 10.1007/s00276-016-1634-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/18/2016] [Indexed: 12/11/2022]
|
30
|
Sampson B, Hammers J. Forensic Aspects of Cardiovascular Pathology. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
31
|
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.
Collapse
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.
| |
Collapse
|
32
|
Cho S, Jeon KN, Bae K. Anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve: MDCT findings. SPRINGERPLUS 2015; 4:426. [PMID: 26290805 PMCID: PMC4539311 DOI: 10.1186/s40064-015-1214-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/03/2015] [Indexed: 11/22/2022]
Abstract
Anomalous origin of the coronary artery taking an interarterial course can cause myocardial infarction or sudden death. Association of anomalous origin of the coronary artery with congenital bicuspid aortic valve is rare, and only a few cases have been reported with imaging findings. Coronary artery aneurysms found in young adults are usually non-atherosclerotic. We report MDCT findings of anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve in a 33-year-old man with a history of Kawasaki disease in the childhood, and the key role of MDCT in exact diagnosis and successful management of the complicated disease.
Collapse
Affiliation(s)
- Soobuem Cho
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 660-702 Korea ; Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 660-702 Korea ; Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyungsoo Bae
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju, 660-702 Korea ; Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| |
Collapse
|
33
|
Anomalous origin of the right coronary artery from the left coronary sinus with an intramural course: comparison between sudden-death and non-sudden-death cases. Cardiovasc Pathol 2015; 24:154-9. [DOI: 10.1016/j.carpath.2014.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/29/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022] Open
|
34
|
Brown LM, Duffy CE, Mitchell C, Young L. A Practical Guide to Pediatric Coronary Artery Imaging with Echocardiography. J Am Soc Echocardiogr 2015; 28:379-91. [DOI: 10.1016/j.echo.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Indexed: 10/24/2022]
|
35
|
Batalis NI, Wassum JA. Coronary Artery Anomalies: Benign Entities or Pathologic Findings? Acad Forensic Pathol 2015. [DOI: 10.23907/2015.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Many cases of sudden, natural death have obvious gross or histologic pathology to which the death can be attributed fairly easily. Sometimes, though, one encounters a death in which an abnormal finding is identified, but there is some hesitancy in attributing the death to it as one may be unfamiliar with the significance of the finding or has encountered it many times before in cases where death was clearly due to something else. Coronary artery anomalies firmly fit into this category for many pathologists. Anomalous origin of the coronary arteries is an uncommon anomaly occurring in a fraction of a percent of individuals, so one may only encounter one or two deaths with this lesion in his/her career. Without past experiences to rely upon, one may be unsure about the severity of the lesion and inadvertently dismiss a significant anomaly or attribute death to a benign variant. Myocardial bridging is on the other end of the spectrum. This entity is seen so commonly that many consider it to be a normal variant and entirely benign and incidental. While this may be true in the majority of individuals, myocardial bridging may cause cardiac dysfunction in a small subset of people. This manuscript will review the anatomy and potential pathophysiology of these anomalies with the goal of aiding the pathologist in certifying deaths in which they are encountered.
Collapse
Affiliation(s)
| | - J. Andrew Wassum
- Medical University of South Carolina - Pathology and Lab Medicine
| |
Collapse
|
36
|
Koronaranomalie als Todesursache bei einem 13 Monate alt gewordenen Jungen. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-1002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Priemer DS, Danon S, Guzman MA. Unexpected cardiac death due to a slit-like left coronary ostium with associated high take-off of the right coronary artery in a previously healthy child. Forensic Sci Med Pathol 2014; 11:124-6. [DOI: 10.1007/s12024-014-9612-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2014] [Indexed: 12/01/2022]
|
38
|
Anatomical criteria of malignancy by computed tomography angiography in patients with anomalous coronary arteries with an interarterial course. Eur Radiol 2014; 25:760-6. [DOI: 10.1007/s00330-014-3454-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/06/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
|
39
|
Yuan SM. Anomalous origin of coronary artery: taxonomy and clinical implication. Braz J Cardiovasc Surg 2014; 29:622-9. [PMID: 25714217 PMCID: PMC4408826 DOI: 10.5935/1678-9741.20140109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/14/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Anomalous origin of coronary artery is uncommon. The taxonomies of anomalous origin of coronary artery are inconsistent and complex. Conceptual and therapeutic debates remain. The aim of the present study is to reappraise the concept of anomalous origin of coronary artery and to discuss the potential hazards and treatment rationale of this anomaly on basis of literature review. METHODS A comprehensive literature review was made in terms of the taxonomies including "simple", "multiple" and "complex" types of anomalous origin of coronary artery. RESULTS Anomalous origin of coronary artery can be simply categorized according to the ectopically originated coronary artery. There are a couple of complex anatomical variants: "multiple" type, involving more than one coronary artery or branch, which can be subdivided into 2 subtypes, A) more than one coronary arteries or branches arising from one place; and B) two coronary arteries/branches arising from separate ectopic sites; and "complex" type, associated with acquired heart disease, or congenital heart defects. CONCLUSION Sudden cardiac death in anomalous origin of coronary artery is associated with the anatomical features including abnormal coursing, acute angle take-off and ostial abnormalities. Atherosclerosis is prone to be in the right-sided ectopic and retroaortic coursing coronary artery. Surgical treatment is a definitive therapy. Simple coronary artery bypass grafting is not recommended due to the potential hazards of coronary steal phenomenon and poor patency of mammary arterial grafts, and modified maneuvers such as coronary ostial reimplantation, impinged coronary segment unroofing and coronary stent deployment are advocated instead.
Collapse
Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian
Medical University, Putian, Fujian Province, People’s Republic of China
| |
Collapse
|
40
|
Abstract
Congenital coronary artery anomalies are rare. Pathologists are exposed to those in mainly two settings; in association with sudden death and usually extreme exercise in young adults, and in association with complex congenital heart disease in the pediatric and perinatal population. Pediatric pathologists, other pathologists and pathologists' assistants performing pediatric or forensic autopsies therefore need to be familiar with coronary artery anomalies.
Collapse
|
41
|
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.
Collapse
Affiliation(s)
- Arthur Nasis
- Monash Cardiovascular Research Centre, MonashHEART, Monash Health, 246 Clayton Road, Clayton, 3168, Australia,
| | | | | | | | | | | |
Collapse
|
42
|
Right Coronary Artery From Right Sinus of Valsalva and Ventricular Tachycardia. Ann Thorac Surg 2014; 98:1091-4. [DOI: 10.1016/j.athoracsur.2013.10.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 09/30/2013] [Accepted: 10/25/2013] [Indexed: 11/19/2022]
|
43
|
Hill SF, Sheppard MN. A silent cause of sudden cardiac death especially in sport: congenital coronary artery anomalies. Br J Sports Med 2013; 48:1151-6. [PMID: 24009012 DOI: 10.1136/bjsports-2013-092195] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM To raise awareness of congenital coronary artery anomalies (CCAAs) as an important cause of sudden cardiac death (SCD) in athletes, we describe a cohort of the malignant subset. Defining the key anatomical features for the cardiologist and pathologist to be aware of and detailing a systematic approach to examining the coronary arteries at autopsy. METHODS Retrospective non-case-controlled analysis of 2304 cases of SCD referred by pathologists between 1994 and January 2012. RESULTS 31 (1.3%) of the 2304 cases of SCD had CCAAs; 24 men (77%) and 7 women (23%), mean age 28 years (range 16 months-63 years). In 15 cases (48%), SCD occurred during or immediately after physical exertion. Cardiac symptoms were documented to have occurred in only seven patients (23%) prior to SCD. The anomaly had been identified by the referring pathologist in only 11 of the 31 cases (35%). CONCLUSIONS CCAAs are a rare and mostly benign entity, but a subset has the potential to be fatal without any forewarning. In a significant proportion of cases identified in this large cohort, the victim was under exertion at the time of death, highlighting the relevance of this anomaly to the sports and exercise medicine community.
Collapse
Affiliation(s)
- Sharleen F Hill
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Mary N Sheppard
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
44
|
Laux D, Bessières B, Houyel L, Bonnière M, Magny JF, Bajolle F, Boudjemline Y, Bonnet D. Early neonatal death and congenital left coronary abnormalities: ostial atresia, stenosis and anomalous aortic origin. Arch Cardiovasc Dis 2013; 106:202-8. [PMID: 23706366 DOI: 10.1016/j.acvd.2013.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/24/2012] [Accepted: 01/10/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Congenital left coronary artery abnormalities such as ostial stenosis or atresia are extremely rare. Diagnosis in the neonate has not been reported. AIMS To describe five neonates with left coronary artery orifice abnormalities and discuss pathophysiology, diagnosis and treatment options, with a focus on the importance of autopsy in unexpected neonatal death. METHODS Retrospective assessment of medical files of neonates with left coronary abnormalities seen during a 12-year period (2000-2012). RESULTS Three neonates with anatomical (n=2) and functional (n=1) left coronary stenosis and two neonates with ostial atresia were identified. The three infants with coronary stenosis died within minutes to days after birth because of cardiac failure refractory to intensive care treatment; at autopsy, left coronary ostial stenosis (n=2) and high take-off with acute angle origin and tangential vertical course (n=1) were diagnosed. The fourth neonate was in cardiac failure due to critical aortic stenosis; left coronary ostial atresia was diagnosed during an emergency catheter procedure and the infant died after aortic valve dilatation. The fifth infant had a cardiac arrest on the third day of life; she was diagnosed with left coronary ostial atresia by coronary angiography and died during attempted revascularization surgery at 2 weeks of life. CONCLUSION Congenital coronary ostial abnormalities can lead to severe heart failure and unexpected neonatal death. Systematic examination of the coronary arteries should be part of any neonatal autopsy. Coronary angiography remains the diagnostic method of choice despite advances in non-invasive imaging. Revascularization surgery seems indicated in symptomatic children based on small patient series.
Collapse
Affiliation(s)
- Daniela Laux
- Centre de référence malformations cardiaques congénitales complexes-M3C-Necker, hôpital Necker enfants-malades, assistance publique des hôpitaux de Paris, université Paris Descartes, Sorbonne Paris-Cité, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Niwa K. Coronary artery anomaly and sudden death-Especially focus on anomalous left coronary artery arising from the right sinus. J Cardiol Cases 2013; 7:e86-e88. [PMID: 30533130 PMCID: PMC6275240 DOI: 10.1016/j.jccase.2012.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Indexed: 12/02/2022] Open
Affiliation(s)
- Koichiro Niwa
- Department of Cardiology and Adult CHD Program, Cardiovascular Center, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
| |
Collapse
|
46
|
A serious cause of syncope in a young patient. Herz 2013; 39:154-5. [DOI: 10.1007/s00059-013-3771-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
|
47
|
Houyel L, Bajolle F, Capderou A, Laux D, Parisot P, Bonnet D. The pattern of the coronary arterial orifices in hearts with congenital malformations of the outflow tracts: a marker of rotation of the outflow tract during cardiac development? J Anat 2013; 222:349-57. [PMID: 23317176 DOI: 10.1111/joa.12023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 11/29/2022] Open
Abstract
Outflow tract defects, including cardiac neural crest defects (so-called conotruncal defects) and transposition of the great arteries, are due to an abnormal rotation of the outflow tract during cardiac development. Coronary orifices are often abnormal in outflow tract defects, particularly in common arterial trunk (CAT). A recent study indicates that abnormal coronary artery pattern in a mouse model with common arterial outlet (Tbx1-/- mouse mutant) could be due to a reduced and malpositioned subpulmonary coronary-refractory myocardial domain. The aim of our study was to demonstrate the relation between coronary orifices pattern in outflow tract defects in human and the abnormal embryonic rotation of the outflow tract. We analyzed 101 heart specimens with outflow tract defects: 46 CAT, 15 tetralogy of Fallot (TOF), 29 TOF with pulmonary atresia (TOF-PA), 11 double-outlet right ventricle with subaortic ventricular septal defect (DORV) and 17 controls. The position of left and right coronary orifices (LCO, RCO) was measured in degrees on the aortic/truncal circumference. The anterior angle between LCO and RCO (α) was calculated. The LCO was more posterior in TOF (31 °), TOF-PA (47 °), DORV (44 °), CAT (63 °), compared with controls (0 °, P < 0.05), and more posterior in CAT than in other outflow tract defects (P < 0.05). The RCO was more anterior in TOF (242 °), TOF-PA (245 °) and DORV (271 °) than in controls (213 °, P < 0.05), but not in CAT (195 °). The α angle was similar in TOF, TOF-PA, DORV and controls (149 °, 162 °, 133 °, 147 °), but significantly larger in CAT (229 °, P < 0.0001). In all outflow tract defects but CAT, the displacement of LCO (anterior) and RCO (posterior), while the α angle remains constant, might be due to incomplete rotation of the myocardium at the base of the outflow tract, leading to an abnormally positioned subpulmonary coronary-refractory myocardial domain. The larger α angle in CAT could reflect its dual identity, aortic and pulmonary.
Collapse
Affiliation(s)
- Lucile Houyel
- Hôpital Marie-Lannelongue, CMR-M3C, Université Paris-Sud, Le Plessis-Robinson, France.
| | | | | | | | | | | |
Collapse
|
48
|
Rigatelli G, Rigatelli A, Cominato S, Panin S, Nghia NT, Faggian G. A clinical-angiographic risk scoring system for coronary artery anomalies. Asian Cardiovasc Thorac Ann 2012; 20:299-303. [PMID: 22718718 DOI: 10.1177/0218492312437880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital coronary anomalies remain a debated issue. On the basis of a critical review of the literature and our historical series, we propose a simple clinical profile scoring system for congenital coronary anomalies. A review of literature over the past 30 years was performed, searching for a relationship between the worst coronary anomaly presentation and manifestations and the anatomical and functional features. A risk scoring system was created based on these features, and retrospectively applied to our historical series of 140 consecutive patients (52 females; mean age, 60.1±19.3 years; mean follow-up, 60±23 months). Origin from the pulmonary artery, intramural course, intramyocardial course, coronary fistula with a significant pulmonary-to-systemic flow ratio, superimposed coronary artery disease, and associated congenital heart disease were associated with the worst clinical presentation. The risk scoring system gave 2 points to anatomical features and 1 point to the association with clinical and functional characteristics: 3 risk classes were identified: >3, 2-3, and <2 points. The system showed good correlation with presentation and manifestations on follow-up. Although not exhaustive, the proposed scoring system may simplify the clinical evaluation of patients with such abnormalities, being a model for decision making.
Collapse
Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital Heart Disease Interventions, Rovigo, General Hospital, Rovigo, Italy.
| | | | | | | | | | | |
Collapse
|
49
|
Lee HJ, Hong YJ, Kim HY, Lee J, Hur J, Choi BW, Chang HJ, Nam JE, Choe KO, Kim YJ. Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus with an Interarterial Course: Subtypes and Clinical Importance. Radiology 2012; 262:101-8. [DOI: 10.1148/radiol.11110823] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
50
|
Nishiyama M, Doi S, Matsumoto A, Nishioka M, Hosokawa S, Sasaki A, Mizutani S. Exercise-induced myocardial ischemia in a case of anomalous origin of the left main coronary artery from the noncoronary sinus of valsalva. Pediatr Cardiol 2011; 32:1028-31. [PMID: 21779965 DOI: 10.1007/s00246-011-0051-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/07/2011] [Indexed: 10/18/2022]
Abstract
We report a case of anomalous origin of the left main coronary artery (LCA) from the noncoronary sinus of valsalva (LCANCS) in a young healthy patient who presented with syncope and cardiopulmonary arrest during exercise. The enhanced computed tomography showed acute angle take-off (AAT) of LCA, and the exercise stress thallium-201 myocardial scintigraphy demonstrated a large defect at the LCA perfusion region. We propose that the coexistence of AAT and resulting ischemia causes sudden cardiac death during exercise in the patients with LCANCS.
Collapse
Affiliation(s)
- Mitsunori Nishiyama
- Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|