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Zhang C, Shi D. Left anomalous coronary artery originating from the opposite sinus causes acute myocardial infarction with syncope in a young woman: A case report. Medicine (Baltimore) 2024; 103:e39850. [PMID: 39331859 DOI: 10.1097/md.0000000000039850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024] Open
Abstract
RATIONALE The left anomalous coronary artery originating from the opposite sinus represents a distinct subtype of anomalous coronary arteries originating from the opposite sinus. A comprehensive overview encompassing clinical characteristics, diagnostic approaches, and treatment modalities for this condition is presented herein. PATIENT CONCERNS The patient, a 17-year-old female, was admitted to the hospital due to chest pain and syncope following multiple exercises. DIAGNOSES After conducting an electrocardiogram, myocardial injury markers, and echocardiography, she was diagnosed with acute myocardial infarction complicated by syncope. Further examinations including coronary angiography, coronary computed tomography angiography, and cardiac magnetic resonance imaging revealed an anomalous origin of the coronary artery with the left coronary artery (LCA) arising from the right sinus and exhibited intramural course. INTERVENTIONS The coronary "unroofing" technique was admitted according to her characteristics. The patient achieved successful recovery after surgery with no recurrence of chest pain or syncope during 1 year of follow-up. OUTCOMES Anomalous origin of the LCA is a rare congenital anatomical anomaly. Surgical intervention represents the primary approach for subsequent management of symptomatic anomalous origin of the coronary artery. Importantly, individuals with anomalous origin of the LCA from the right coronary sinus are at potential risk of sudden cardiac death. LESSONS Therefore, enhancing diagnostic precision and actively pursuing surgical treatment in confirmed diagnoses can effectively mitigate myocardial ischemia and prevent instances of sudden cardiac death among adolescents and athletes.
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Affiliation(s)
- Cheng Zhang
- Department of Cardiology, Jilin University Bethune Third Clinical Hospital, Changchun, Jilin Province, P. R. China
| | - Dan Shi
- Department of Radiotherapy, Jilin University Bethune Third Clinical Hospital, Changchun, Jilin Province, P. R. China
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2
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Gil BM, Chang S, Beck KS, Lee W, Lee HJ, Choo KS, Chung MH, Kim TH, Jung JI. Evaluating the Association between Anomalous Aortic Origin of the Right Coronary Artery from the Left Sinus with Interarterial Course at Coronary CT Angiography and Sudden Cardiac Death. Radiol Cardiothorac Imaging 2024; 6:e230407. [PMID: 39023372 PMCID: PMC11369655 DOI: 10.1148/ryct.230407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/17/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024]
Abstract
Purpose To investigate the association between the anomalous aortic origin of the right coronary artery (R-AAOCA) from the left coronary sinus with interarterial course (IAC) found at coronary CT angiography and sudden cardiac death using a large data set from five university hospitals. Materials and Methods From a total of 89 314 CCTA scans (January 2009 to December 2016) that were retrospectively collected, 316 patients with R-AAOCA from the left sinus with IAC were retrospectively collected. After excluding patients with less than 2 years of follow-up, patients who had already undergone cardiovascular surgery or intervention, and patients with arrhythmia or heart failure before undergoing coronary CT angiography, 224 patients were analyzed. Follow-up was terminated upon the occurrence of major adverse cardiovascular events (MACE). Logistic regression was used to identify clinical and radiologic information as independent predictors of MACE. Results The period prevalence of R-AAOCA from the left sinus with IAC was 0.354%. The mean age was 62.03 years, with a male-to-female ratio of 182:134. During follow-up, 19 of 224 patients (8.5%) experienced MACE, but none had sudden cardiac death. Of these cases, only seven (3.13%) were suspected of being due to R-AAOCA from the left sinus with IAC and all of them had unstable angina. Coronary artery disease was significantly associated with MACE (P < .001), while no significant correlation was observed with radiologic features. Conclusion Sudden cardiac death was not associated with R-AAOCA from the left sinus with IAC found at coronary CT angiography. The occurrence of MACE was low, with coronary artery disease being the sole significant predictor of a patient's prognosis. Keywords: Anomalous Aortic Origin of the Right Coronary Artery, Left Coronary Sinus with Interarterial Course, Coronary CT Angiography, Sudden Cardiac Death Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Bo Mi Gil
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Suyon Chang
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Kyongmin Sarah Beck
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Whal Lee
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Hye-Jeong Lee
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Ki Seok Choo
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Myung Hee Chung
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Tae Hoon Kim
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Jung Im Jung
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
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Evangelista M, Ferrero P, D’Aiello AF, Negura D, Micheletti A, Bevilacqua F, Pasqualin G, Chessa M. Coronary artery anomalies: what are they? when to suspect? how to treat?-a narrative review. Transl Pediatr 2024; 13:1242-1257. [PMID: 39144437 PMCID: PMC11320013 DOI: 10.21037/tp-24-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/18/2024] [Indexed: 08/16/2024] Open
Abstract
Background and Objective In the literature have been widely discussed different classification criteria for coronary artery anomalies (CAAs), some authors have tried to categorize them only as "major" or "hemodynamically significant" anomalies versus "minor" or "not hemodynamically significant" ones. However, the most recent literature has concluded that all possible coronary anatomy should be taken into consideration in a comprehensive classification of CAAs. The aim of the article is to review the most recent literature regarding CAAs to provide a comprehensive overview of this challenging topic. Methods We propose a narrative overview of the most impactful and recent literature, synthetizing and re-elaborating the most important articles concerning CAAs. Key Content and Findings The important gap of knowledge on the specific characteristics of CAAs has led to a progressively increased interest of the current research in this field. Albeit their nature is still unclear, an increased awareness of their fatality is spreading among clinicians and the general population, mostly associated with their clinical relevance among young patients and athletes. On the other side, we do believe that clinical and hemodynamic repercussions are of crucial importance and should always be integrated to understand the true nature of this important pathology. Conclusions In the field of pediatric cardiology, CAAs are one of the most fascinating and studied subject. We propose a state-of-the art review to provide a comprehensive and systematic description and subsequently an approach to the epidemiological, pathophysiological, and clinical aspects of the most important CAAs in the pediatric population.
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Affiliation(s)
- Martina Evangelista
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Ferrero
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Angelo Fabio D’Aiello
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Diana Negura
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Angelo Micheletti
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesca Bevilacqua
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giulia Pasqualin
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Massimo Chessa
- ACHD Unit-Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
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4
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Wu Y, Che S, Li Y. An unusual cause of cardiac arrest in a young infant. BMC Cardiovasc Disord 2024; 24:370. [PMID: 39020323 PMCID: PMC11253404 DOI: 10.1186/s12872-024-04028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/03/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Anomalous aortic origin of a coronary artery from the inappropriate sinus of Valsalva (AAOCA) is a rare congenital heart lesion. It is uncommon for patients with AAOCA to present with severe symptoms at a very young age. CASE PRESENTATION We describe a very rare but critical presentation in a young infant with AAOCA that requires surgical repair and pacemaker placement. A three-month-old infant was referred because of syncope. Cardiac arrest occurred shortly after admission. The electrocardiogram indicated a complete atrioventricular block and a transvenous temporary pacemaker was implanted. A further coronary computed tomographic angiography (CTA) showed the anomalous origin of the right coronary artery from the left sinus of Valsalva. Coronary artery unroofing was performed due to an interarterial course with the intramural component, and a permanent epicardial pacemaker was implanted. The postoperative recovery was uneventful, and this patient was thriving and asymptomatic at the nine-month follow-up. However, the electrocardiogram still indicated a complete pacing rhythm. CONCLUSIONS By timely diagnosis and treatment, this patient is successfully rescued. Although rare, AAOCA may be fatal even in infants.
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Affiliation(s)
- Yuhao Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Siyi Che
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yonggang Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Chongqing, China.
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5
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Fuenzalida JJV, Becerra-Rodriguez ES, Quivira Muñoz AS, Baez Flores B, Escalona Manzo C, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibañez A, Bruna-Mejias A, Sanchis-Gimeno J, Gutiérrez-Espinoza H, Granite G. Anatomical Variants of the Origin of the Coronary Arteries: A Systematic Review and Meta-Analysis of Prevalence. Diagnostics (Basel) 2024; 14:1458. [PMID: 39001347 PMCID: PMC11241028 DOI: 10.3390/diagnostics14131458] [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: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
PURPOSE The most common anomaly is an anomalous left coronary artery originating from the pulmonary artery. These variants can be different and depend on the location as well as how they present themselves in their anatomical distribution and their symptomatological relationship. For these reasons, this review aims to identify the variants of the coronary artery and how they are associated with different clinical conditions. METHODS The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. RESULTS A total of 39 studies met the established selection criteria. In this study, 21 articles with a total of 578,868 subjects were included in the meta-analysis. The coronary artery origin variant was 1% (CI = 0.8-1.2%). For this third sample, the funnel plot graph showed an important asymmetry, with a p-value of 0.162, which is directly associated with this asymmetry. CONCLUSIONS It is recommended that patients whose diagnosis was made incidentally and in the absence of symptoms undergo periodic controls to prevent future complications, including death. Finally, we believe that further studies could improve the anatomical, embryological, and physiological understanding of this variant in the heart.
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Affiliation(s)
- Juan José Valenzuela Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago 8370993, Chile
| | | | | | - Belén Baez Flores
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
| | - Catalina Escalona Manzo
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
| | | | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile
| | | | - Alejandro Bruna-Mejias
- Departamento de Ciencias y Geografía, Facultad de Ciencias Naturales y Exactas, Universidad de Playa Ancha, Valparaíso 2360072, Chile
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain
| | | | - Guinevere Granite
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Conte E, Marchetti D, Melotti E, Schillaci M, Mushtaq S, Maffi V, Pontone G, Bartorelli A, Andreini D. Clinical and cardiac CT characteristics of congenital coronary abnormalities occasionally detected in a middle-aged population: A long-term follow-up study. J Cardiovasc Comput Tomogr 2024; 18:375-382. [PMID: 38641453 DOI: 10.1016/j.jcct.2024.04.002] [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] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Congenital coronary artery anomalies (CCAA) represent one of the most challenging conditions as their clinical presentation may range from sudden cardiac death to a complete subclinical form. The aim of the present study was to evaluate the diagnostic and prognostic role of cardiac CT (CCT) evaluation in patients with CCAA, focusing on anomalies of origin. MATERIAL AND METHODS The present is a retrospective analysis of a prospective clinical registry including a consecutive cohort of patients who underwent clinically indicated CCT from January 2007 to October 2015 for suspected but unknown coronary artery disease (CAD) and were diagnosed for having a congenital coronary abnormality compared to a control group matched for age, sex and segment stenosis score (SSS). Dedicated analysis of all CCT was performed for the present study and only coronary anomalies of origin were considered and included in the study. Two different composite end-points were identified for the present analysis: major cardiovascular events (MACE) and all-cause of death. RESULTS Among the 81 patients with CCAAs enrolled the most frequent anomaly was left main artery absence, which was identified in 41 individuals (50.6%). Forty-five subjects (55.5%) have an anomalous origin of the coronary artery from a different sinus of Valsalva and 45 subjects had also an anomalous course with the retro-aortic being the most common (32%). Eleven participants (13.6%) displayed also an intramural segment, while 10 (10.3%) had a slit-like ostial morphology. At multivariate analysis CT identification of ARCA, anomalous inter-arterial course and abnormal ostial morphology were significantly associated with MACE even when adjusted for age and SSS, without any differences in all-cause mortality between the two groups (6.2% vs 2.4% p = 0.2478). CONCLUSION The result of the present study is that CCT can be successfully used to define the anatomy and features of CAA. It suggested that in middle-aged patients, the identification of high risk characteristics at CT may have a prognostic value in term of cardiovascular events occurrence at follow-up even if the rate of events strictly linked to CCAA is low.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | - Vanessa Maffi
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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7
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Hooda Z, Rifai Y, LeBow E, Bustamante JP, Cerda L, Zaku B. Surgical management of anomalous aortic right coronary artery discovered during acute type A aortic dissection: a case report. J Surg Case Rep 2024; 2024:rjae348. [PMID: 39005632 PMCID: PMC11245676 DOI: 10.1093/jscr/rjae348] [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: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 07/16/2024] Open
Abstract
Anomalous aortic origin of the right coronary artery (RCA) is a rare anatomic anomaly that is present in ~1% of the general population, and is often discovered incidentally through imaging performed for another purpose. Despite being an uncommon phenomenon, aberrant right coronary arterial origins can have devastating manifestations in half of affected patients. These include myocardial infarction, arrhythmias, heart failure, syncope, and sudden cardiac death secondary to ischemia of the cardiac tissue. This report describes a case of a 48-year-old female patient that was initially found to have ST-elevation myocardial infarction. During cardiac catheterization, the patient was discovered to have a type A aortic dissection. Cardiothoracic surgery was consulted, and she was immediately transferred to the operating room for repair. During the procedure, an anomalous RCA was discovered with its origin in the dissected tissue, which was initially ligated and then bypassed using greater saphenous vein graft.
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Affiliation(s)
- Zamaan Hooda
- Department of Cardiothoracic Surgery, St. Joseph’s University Medical Center, Paterson, NJ 07503, United States
| | - Yasmine Rifai
- Department of Surgery, Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
| | - Elissa LeBow
- Department of Cardiothoracic Surgery, St. Joseph’s University Medical Center, Paterson, NJ 07503, United States
| | - John Paul Bustamante
- Department of Cardiothoracic Surgery, St. Joseph’s University Medical Center, Paterson, NJ 07503, United States
| | - Luis Cerda
- Department of Cardiothoracic Surgery, St. Joseph’s University Medical Center, Paterson, NJ 07503, United States
| | - Bledi Zaku
- Department of Cardiothoracic Surgery, St. Joseph’s University Medical Center, Paterson, NJ 07503, United States
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8
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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [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] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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9
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Serafini L, Piazzani M, Madureri A, Giacomarra G, Elia S, Chizzola G, Metra M, Adamo M. Anomalous origin of the coronary arteries: a brief summary for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:364-369. [PMID: 38555582 DOI: 10.2459/jcm.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Lisa Serafini
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | | | | | | | - Stefano Elia
- Radiology Unit, ASST Valcamonica, Esine, Brescia, Italy
| | - Giuliano Chizzola
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
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10
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Pascaner AF, Rosato A, Fantazzini A, Vincenzi E, Basso C, Secchi F, Lo Rito M, Conti M. Automatic 3D Segmentation and Identification of Anomalous Aortic Origin of the Coronary Arteries Combining Multi-view 2D Convolutional Neural Networks. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:884-891. [PMID: 38343261 PMCID: PMC11031525 DOI: 10.1007/s10278-023-00950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 04/20/2024]
Abstract
This work aimed to automatically segment and classify the coronary arteries with either normal or anomalous origin from the aorta (AAOCA) using convolutional neural networks (CNNs), seeking to enhance and fasten clinician diagnosis. We implemented three single-view 2D Attention U-Nets with 3D view integration and trained them to automatically segment the aortic root and coronary arteries of 124 computed tomography angiographies (CTAs), with normal coronaries or AAOCA. Furthermore, we automatically classified the segmented geometries as normal or AAOCA using a decision tree model. For CTAs in the test set (n = 13), we obtained median Dice score coefficients of 0.95 and 0.84 for the aortic root and the coronary arteries, respectively. Moreover, the classification between normal and AAOCA showed excellent performance with accuracy, precision, and recall all equal to 1 in the test set. We developed a deep learning-based method to automatically segment and classify normal coronary and AAOCA. Our results represent a step towards an automatic screening and risk profiling of patients with AAOCA, based on CTA.
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Affiliation(s)
- Ariel Fernando Pascaner
- Department of Civil Engineering and Architecture, University of Pavia, Via Adolfo Ferrata 3, 27100, Pavia, Italy
| | - Antonio Rosato
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Alice Fantazzini
- Camelot Biomedical Systems S.r.l., Via Al Ponte Reale 2/20, 16124, Genoa, Italy
| | - Elena Vincenzi
- Camelot Biomedical Systems S.r.l., Via Al Ponte Reale 2/20, 16124, Genoa, Italy
| | - Curzio Basso
- Camelot Biomedical Systems S.r.l., Via Al Ponte Reale 2/20, 16124, Genoa, Italy
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097, San Donato Milanese, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Via Adolfo Ferrata 3, 27100, Pavia, Italy.
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11
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Gaudino M, Di Franco A, Arbustini E, Bacha E, Bates ER, Cameron DE, Cao D, David TE, De Paulis R, El-Hamamsy I, Farooqi KM, Girardi LN, Gräni C, Kochav JD, Molossi S, Puskas JD, Rao SV, Sandner S, Tatoulis J, Truong QA, Weinsaft JW, Zimpfer D, Mery CM. Management of Adults With Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review. Ann Thorac Surg 2023; 116:1124-1141. [PMID: 37855783 DOI: 10.1016/j.athoracsur.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/20/2023]
Abstract
As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a systematic review and critical evaluation of the available evidence on the interventional treatment of AAOCA in adult patients. Using a structured Delphi process, the group agreed on expert recommendations that are intended to complement existing clinical practice guidelines.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, IRCCS and Polyclinic San Matteo Foundation, Pavia, Italy
| | - Emile Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Eric R Bates
- Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Tirone E David
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy; UniCamillus University, Rome, Italy
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan D Kochav
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Silvana Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sunil V Rao
- Division of Interventional Cardiology, NYU Langone Health, New York, New York
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Quynh A Truong
- Department of Radiology, New York Presbyterian, Weill Cornell Medicine, New York, New York
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School at The University of Texas at Austin/Dell Children's Medical Center, Austin, Texas
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12
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Gaudino M, Di Franco A, Arbustini E, Bacha E, Bates ER, Cameron DE, Cao D, David TE, De Paulis R, El-Hamamsy I, Farooqi KM, Girardi LN, Gräni C, Kochav JD, Molossi S, Puskas JD, Rao SV, Sandner S, Tatoulis J, Truong QA, Weinsaft JW, Zimpfer D, Mery CM. Management of Adults With Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review. J Am Coll Cardiol 2023; 82:2034-2053. [PMID: 37855757 DOI: 10.1016/j.jacc.2023.08.012] [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: 05/15/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 10/20/2023]
Abstract
As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a systematic review and critical evaluation of the available evidence on the interventional treatment of AAOCA in adult patients. Using a structured Delphi process, the group agreed on expert recommendations that are intended to complement existing clinical practice guidelines.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, IRCCS and Polyclinic San Matteo Foundation, Pavia, Italy
| | - Emile Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Eric R Bates
- Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Tirone E David
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy; UniCamillus University, Rome, Italy
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan D Kochav
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Silvana Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sunil V Rao
- Division of Interventional Cardiology, NYU Langone Health, New York, New York, USA
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Quynh A Truong
- Department of Radiology, New York Presbyterian, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School at The University of Texas at Austin/Dell Children's Medical Center, Austin, Texas, USA
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13
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Angelini P, Uribe C, Corno AF. Pathophysiology and Treatment of Intraseptal-Course Left Coronary Anomaly: Surgery for All? Pediatr Cardiol 2023:10.1007/s00246-023-03328-1. [PMID: 37943349 DOI: 10.1007/s00246-023-03328-1] [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] [Received: 03/24/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Intraseptal-course, ectopic coronary anomalies are not well characterized as to anatomy, function, prognosis, and treatment. Recently, a revolutionary but unsupported new theory is claiming that most patients with a Left Anomalous Coronary Artery originating from the Opposite Sinus with anomalous Intra-Septal course (L-ACAOS-IS)-even small children-have significant stenoses and require open-heart surgery to prevent acute myocardial infarction and death. This surprising view has spurred ongoing discussions among adult and pediatric cardiologists and cardiac surgeons, compelling us (the conservative party in the discussion) to offer an in-depth and comprehensive review of this anomaly, based on objective but opposite data. We and other adult cardiologists have followed numerous L-ACAOS-IS patients for many years and have observed none of the claimed catastrophes. Rather, we have consistently found that L-ACAOS-IS generally has a benign clinical prognosis. We present the general principle of coronary artery dysfunction in anatomical congenital anomalies (that only significant luminal coronary stenosis can have clinical repercussions). We then review anatomical and functional details of L-ACAOS-IS related to prognosis and treatment indications, which could explain many of the clinical presentations recently mentioned. Finally, we encourage our more liberal colleagues to recognize that, compared with normal coronary arteries, those with anomalies of origin and course are associated with frequent coronary spasm. In particular, we underscore that some of the ischemic manifestations and other results might actually be caused by pressure wire-induced artifacts (rigid wires tend to cause coronary spasm when advanced into tortuous coronary arteries).
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Affiliation(s)
- Paolo Angelini
- The Texas Heart Institute Center for Cardiovascular Care, Houston, TX, USA
| | - Carlo Uribe
- The Texas Heart Institute Center for Cardiovascular Care, Houston, TX, USA
| | - Antonio F Corno
- School of Engineering, University of Leicester, University Road, Leicester, LE1 7RH, UK.
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14
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Lau WR, Lee PT, Koh CH. Coronary Artery Anomalies - State of the Art Review. Curr Probl Cardiol 2023; 48:101935. [PMID: 37433414 DOI: 10.1016/j.cpcardiol.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Abstract
Coronary artery anomalies (CAAs) comprise a wide spectrum of anatomic entities, with diverse clinical phenotypes. We present a case of an anomalous right coronary artery arising from the left aortic sinus with an interarterial course, a potentially fatal condition that can precipitate ischemia and sudden cardiac death. CAAs are increasingly detected in adults, mostly as incidental findings in the course of cardiac evaluation. This is due to the expanding use of invasive and noninvasive cardiac imaging, usually in the work-up for possible CAD. The prognostic implications of CAAs in this group of patients remain unclear. In AAOCA patients, appropriate work-up with anatomical and functional imaging should be performed for risk stratification. An individualized approach to management should be adopted, considering symptoms, age, sporting activities and the presence of high-risk anatomical features and physiologic consequences (such as ischemia, myocardial fibrosis, or cardiac arrhythmias) detected on multimodality imaging or other functional cardiac investigations. This comprehensive and up to date review seeks to crystallize current data in the recent literature, and proposes a clinical management algorithm for the clinician faced with the conundrum of managing such conditions.
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Affiliation(s)
- Wei Ren Lau
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Phong Teck Lee
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore
| | - Choong Hou Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS School of Medicine, National University of Singapore, Singapore; Changi Aviation Medical Centre, Changi General Hospital, Singapore.
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15
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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.
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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.
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16
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Katoh Y, Ohki S, Yamaguchi R, Miki T, Nagasawa A, Okonogi S, Yasuhara K, Obayashi T. Direct Coronary Artery Reimplantation of Anomalous Aortic Origin of the Right Coronary Artery: A Case Report. Cureus 2023; 15:e45205. [PMID: 37842345 PMCID: PMC10576222 DOI: 10.7759/cureus.45205] [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] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital cardiac abnormality. Although AAOCA can cause angina, syncope, palpitations, and sudden cardiac death, most patients remain asymptomatic. A 60-year-old woman experienced occasional chest discomfort. A coronary computed tomography (CT) showed that the right coronary artery (RCA) originated from the left sinus of Valsalva, indicating AAORCA. Exercise myocardial scintigraphy revealed ischemia in the inferior wall. Cardiac catheterization showed stenosis in the ostium of the RCA. Therefore, direct reimplantation of the RCA into the right sinus was performed under cardiopulmonary bypass. The patient recovered uneventfully, postoperatively. Postoperative coronary CT showed no evidence of bending or stenosis in the RCA. Moreover, exercise scintigraphy showed no ischemic changes. The patient was discharged on postoperative day 18 after the resolution of chest discomfort and remained healthy for the following one year. AAORCA is a rare congenital abnormality that could lead to sudden cardiac death. Appropriate imaging studies and surgery should be performed in symptomatic patients with AAORCA who have inter-arterial paths between the ascending aorta and pulmonary artery with right coronary ostial stenosis. Reimplantation of the RCA directly into the right coronary sinus with adequate mobilization of the RCA is a simple procedure that can return the anatomic and biophysiologic status of AAORCA patients to normal and resolve most morphologic abnormalities.
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Affiliation(s)
- Yusuke Katoh
- Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, JPN
| | - Satoshi Ohki
- Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, JPN
| | - Ryo Yamaguchi
- Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, JPN
| | - Takao Miki
- Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, JPN
| | - Ayako Nagasawa
- Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, JPN
| | - Shuichi Okonogi
- Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, JPN
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17
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Ratti A, Prestini B, Conte E, Marchetti D, Schillaci M, Melotti E, Belmonte M, Mushtaq S, Dessani MA, Pizzamiglio F, Tundo F, Zeppilli P, Bartorelli A, Andreini D. Anomalous origin of left circumflex artery from the right sinus of Valsalva: Clinical outcomes in a consecutive series of master athletes. Clin Cardiol 2023; 46:1097-1105. [PMID: 37735845 PMCID: PMC10540012 DOI: 10.1002/clc.24120] [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: 03/31/2023] [Revised: 07/03/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Aim of the study was to collect and describe a case series of consecutive master athletes in whom an anomalous origin of left circumflex artery (LCx) from the right sinus of Valsalva (ALCx) was detected at a clinically indicated coronary computed tomography angiography CCTA) to establish a focused clinical management and counseling about sport activity in those subjects. METHODS We analyzed a prospective registry of subjects referred to a clinically indicated CCTA. Information about the clinical status was obtained by previous clinical records and clinical evaluation at time of image acquisition; follow-up allowed to record symptoms, outcomes and downstream testing. RESULTS The study population consisted in 14 subjects, of which one competitive athlete and 13 recreational master athletes. Mean age was of 67.2 ± 10.6 years (71% of male); follow-up lasted 6.4 ± 2.6 years. The major high-risk anatomy features (inter-arterial course, intramural segment, high take-off and slit-like ostium) were absent. None had abnormal ostial morphology and all had full retroaortic course; three subjects (21%) presented an acute take-off angle. Coronary artery disease (CAD) was present in 10 patients (71%). Major outcomes (cardiac hospitalization, death for all causes) recorded were not related to the anomalous LCx. Symptoms were most related to atherosclerotic CAD in different vessels whereas two subjects without CAD exhibited cardiac symptoms, without hospitalization. CONCLUSIONS Our study suggests that the diagnosis of ALCx, being usually associated to low-risk anatomical characteristics, could be considered a benign finding, with scarce or no implications for physically active individuals neither for recreational athletes.
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Affiliation(s)
- Angelo Ratti
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Blanca Prestini
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Edoardo Conte
- Division of University CardiologyIRCCS Ospedale Galeazzi Sant'AmbrogioMilanItaly
| | - Davide Marchetti
- Division of University CardiologyIRCCS Ospedale Galeazzi Sant'AmbrogioMilanItaly
| | - Matteo Schillaci
- Division of University CardiologyIRCCS Ospedale Galeazzi Sant'AmbrogioMilanItaly
| | - Eleonora Melotti
- Division of University CardiologyIRCCS Ospedale Galeazzi Sant'AmbrogioMilanItaly
| | - Marta Belmonte
- Cardiovascular Center AalstOLV ClinicAalstBelgium
- Department of Advanced Biomedical SciencesUniversity Federico IINaplesItaly
| | - Saima Mushtaq
- Sport Cardiology UnitCentro Cardiologico Monzino, IRCCSMilanItaly
| | | | | | - Fabrizio Tundo
- Sport Cardiology UnitCentro Cardiologico Monzino, IRCCSMilanItaly
| | - Paolo Zeppilli
- Sports Medicine UnitFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly
| | - Antonio Bartorelli
- Division of University CardiologyIRCCS Ospedale Galeazzi Sant'AmbrogioMilanItaly
| | - Daniele Andreini
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanItaly
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18
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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.
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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
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Verheijen DB, Egorova AD, Jongbloed MR, van der Kley F, Koolbergen DR, Hazekamp MG, Lamb HJ, Jukema JW, Kiès P, Vliegen HW. Anomalous Aortic Origin of the Right Coronary Artery: Invasive Haemodynamic Assessment in Adult Patients With High-Risk Anatomic Features. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:124-133. [PMID: 37969355 PMCID: PMC10642095 DOI: 10.1016/j.cjcpc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 11/17/2023]
Abstract
Background Anomalous aortic origin of a right coronary artery (AAORCA) with an interarterial course merits further evaluation; however, robust risk assessment strategies for myocardial ischemia and sudden cardiac death are currently lacking. The aim of this study is to explore the potential role of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and intravascular ultrasound (IVUS) in patients with AAORCA. Methods Consecutive adult patients with AAORCA with an interarterial course were included. Computed tomography angiography, noninvasive ischemia detection, and FFR, iFR, and IVUS were performed at baseline and during adrenaline-induced stress. External compression was evaluated with IVUS. Results Eight patients (63% female, mean age: 53 ± 9.5 years) were included. Five patients (63%) were symptomatic, and computed tomography angiography revealed high-risk anatomy of the AAORCA in all patients. Only in 1 (12.5%) patient FFR and iFR were positive; however, this was attributed at large to concomitant diffuse atherosclerosis. In 2 of 8 (25%), IVUS revealed external compression; however, the ostial coronary surface area remained unchanged. In all patients, a conservative treatment strategy was pursued. During a mean follow-up of 29.3 months (standard deviation ±2.6 months), symptoms spontaneously disappeared in 4 of 5 (80%) and no adverse cardiac events occurred in any of the patients. Conclusions Despite the presence of high-risk anatomy in all patients, none had proven ischemia prompting a conservative treatment strategy. No adverse cardiac events occurred during follow-up, and in the majority of patients, symptoms spontaneously disappeared. Therefore, FFR, iFR, and IVUS with pharmacologic stress merit further investigation and might contribute to ischemia-based risk stratification and management strategies in adult patients with AAORCA.
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Affiliation(s)
- Diederick B.H. Verheijen
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anastasia D. Egorova
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique R.M. Jongbloed
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dave R. Koolbergen
- Department of Cardiothoracic Surgery, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark G. Hazekamp
- Department of Cardiothoracic Surgery, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J. Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Philippine Kiès
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hubert W. Vliegen
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center, Leiden, the Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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20
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Capisizu AS, Cuzino D, Stanciu SM. A Pilot Study on the Role of Computed Tomography in the Management of Patients with Coronary Artery Anomalies in Romania. J Cardiovasc Dev Dis 2023; 10:jcdd10040170. [PMID: 37103049 PMCID: PMC10142656 DOI: 10.3390/jcdd10040170] [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: 03/22/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in a Romanian sample of patients, investigated with computed tomography angiography for coronary artery disease. The objectives of the study were to identify the anomalies of the coronary arteries and to conduct an anatomical classification according to Angelini. The study also consisted of evaluations regarding coronary artery calcification in the sample of patients by the Agatston calcium score and assessments regarding the presence of cardiac symptoms and their association with coronary abnormalities. The results showed a prevalence of coronary anomalies of 8.7%, of which 3.8% were origin and course anomalies and 4.9% were coronary anomalies with intramuscular bridging of the left anterior descending artery. Recommendations for practice include the widespread use of coronary computed tomography angiography for the diagnosis of coronary artery anomalies and coronary artery disease in larger patient groups and encouraging this investigation across the country.
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Affiliation(s)
- Adriana Sorina Capisizu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
| | - Dragos Cuzino
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Clinical Radiology-Medical Imaging Center, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei Str., 010825 Bucharest, Romania
| | - Silviu Marcel Stanciu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Center for Cardiovascular Diseases, Laboratory of Noninvasive Cardiovascular Functional Explorations, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei Str., 010825 Bucharest, Romania
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21
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Padilla-Serrano A, Fernández-Sánchez JA, De la Chica Ruíz-Ruano R. Origen aórtico anómalo de las arterias coronarias y muerte súbita cardiaca. Med Clin (Barc) 2023:S0025-7753(23)00112-4. [PMID: 37005120 DOI: 10.1016/j.medcli.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
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22
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Pérez-Rojas FJ, Lizama PM, Maragaño MI, Opazo FS, Osorio CT, Castro TZ, Vega JA. Atypical origin of the left coronary artery originating from the right coronary sinus with interarterial course: A case report. TRANSLATIONAL RESEARCH IN ANATOMY 2023. [DOI: 10.1016/j.tria.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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23
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Amioka N, Nakamura K, Matsuo N, Watanabe A, Kotani Y, Kasahara S, Ito H. Repeated Syncope During Exercise as a Result of Anomalous Origin of Left Coronary Artery With Intramural Aortic Course in a Teenage Boy. Tex Heart Inst J 2022; 49:489427. [PMID: 36538599 PMCID: PMC9809068 DOI: 10.14503/thij-21-7677] [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: 12/24/2022]
Abstract
Anomalous origin of the left coronary artery from the opposite sinus of Valsalva with an intramural aortic course (L-ACAOS-IM) can cause syncope, sometimes as a prodrome of lethal events, including sudden cardiac death, in young athletes. The detailed mechanism of syncope in patients with L-ACAOS-IM is still unclear. This case report describes a 17-year-old boy who presented to the hospital because of syncope following chest pain with increasing frequency during exercise, such as playing soccer and running. In a treadmill exercise test, a decrease in blood pressure was seen (from 99/56 mm Hg to 68/38 mm Hg); chest pain and faintness accompanied by ST-segment elevation in lead aVR and ST-segment depression at other leads on electrocardiography were noted. These findings and symptoms disappeared spontaneously within a few minutes while clinicians prepared for emergency medications. Coronary computed tomography angiography (CCTA) showed that the origin of the left coronary artery (LCA) was the opposite sinus of Valsalva, and the course of the LCA was through the aortic wall toward the left coronary sinus. He was diagnosed with L-ACAOS-IM. After surgical treatment by unroofing the intramural part of the LCA and reconstructing a neo-ostium, he no longer experienced syncope during exercise. This case suggests that low cardiac output caused by myocardial ischemia, not life-threatening arrythmia, is a main mechanism of syncope in patients with L-ACAOS-IM. Consideration should be given to performing CCTA before an exercise stress test for young patients with syncope and chest pain to avoid the risk of severe myocardial ischemia.
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Affiliation(s)
- Naofumi Amioka
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naoaki Matsuo
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
, Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
, Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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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.
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25
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Bigler MR, Kadner A, Räber L, Ashraf A, Windecker S, Siepe M, Padalino MA, Gräni C. Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing. J Am Heart Assoc 2022; 11:e027098. [PMID: 36205254 DOI: 10.1161/jaha.122.027098] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are a challenge because of their various anatomic and clinical presentation. Although the prevalence is low, the absolute numbers of detected ACAOS are increasing because of the growing use of noninvasive anatomical imaging for ruling out coronary artery disease. As evidence-based guidelines are lacking, treating physicians are left in uncertainty for the optimal management of such patients. The sole presence of ACAOS does not justify surgical correction, and therefore a thorough anatomic and hemodynamic assessment is warranted. Invasive and noninvasive multimodality imaging provides information to the clinical question whether the presence of ACAOS is an innocent coincidental finding, is responsible for the patient's symptoms, or even might be a risk for sudden cardiac death. Based on recent clinical data, focusing on the pathophysiology of patients with ACAOS, myocardial ischemia is dependent on both the extent of fixed and dynamic components, represented by anatomic high-risk features. These varying combinations should be considered individually in the decision making for the different therapeutic options. This state-of-the-art review focuses on the advantages and limitations of the common contemporary surgical, interventional, and medical therapy with regard to the anatomy and pathophysiology of ACAOS. Further, we propose a therapeutic management algorithm based on current evidence on multimodality invasive and noninvasive imaging findings and highlight remaining gaps of knowledge.
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Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Alexander Kadner
- Centre for Congenital Heart Disease, Department of Cardiovascular Surgery Inselspital Bern Switzerland
| | - Lorenz Räber
- 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
| | - Stephan Windecker
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Matthias Siepe
- Centre for Congenital Heart Disease, Department of Cardiovascular Surgery Inselspital Bern Switzerland
| | - Massimo Antonio Padalino
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardio-Thoracic and Vascular Sciences, and Public Health University of Padova, Medical School Padova Italy
| | - Christoph Gräni
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
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26
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Qasim A, Doan TT, Dan Pham T, Reaves-O'Neal D, Sachdeva S, Mery CM, Binsalamah Z, Molossi S. Is Exercise Stress Testing Useful for Risk Stratification in Anomalous Aortic Origin of a Coronary Artery? Semin Thorac Cardiovasc Surg 2022; 35:759-768. [PMID: 36041683 DOI: 10.1053/j.semtcvs.2022.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Data on maximal exercise-stress-testing (m-EST) in anomalous-aortic-origin-of-coronary-arteries (AAOCA) is limited and correlation with stress perfusion imaging has not been demonstrated. AAOCA patients ≤20 years were prospectively enrolled from 6/2014-01/2020. A m-EST was defined as heart rate >85%ile on ECG-EST and respiratory-exchange-ratio ≥1.05 on cardiopulmonary-exercise-testing (CPET). Abnormal m-EST included significant ST-changes or high-grade arrhythmia, V̇O2max and/or O2 pulse <85% predicted, or abnormal O2 pulse curve. A (+) dobutamine-stress cardiac-magnetic-resonance-imaging (+DS-CMR) had findings of inducible-ischemia. Outcomes: (1) Differences in m-EST based on AAOCA-type; (2) Assuming DS-CMR as gold-standard for detection of inducible ischemia, determine agreement between m-EST and DS-CMR. A total of 155 AAOCA (right, AAORCA = 126; left, AAOLCA = 29) patients with a median (IQR) age of 13 (11-15) years were included; 63% were males and a m-EST was completed in 138 (89%). AAORCA and AAOLCA had similar demographic and m-EST characteristics, although AAOLCA had more frequently evidence of inducible ischemia on m-EST (P = 0.006) and DS-CMR (P = 0.007). Abnormal O2 pulse was significantly associated with +DS-CMR (OR 5.3, 95% CI 1.6-18,P = 0.005). Sensitivity was increased with addition of CPET to ECG-EST (to 58% from 19%). There was no agreement between m-EST and DS-CMR for detection of inducible ischemia. A m-EST has very low sensitivity for detection of inducible ischemia in AAOCA, and sensitivity is increased with addition of CPET. Stress perfusion abnormalities on DS-CMR were notconcordant with m-EST findings and adjunctive testing should be considered for clinical decision making in AAOCA.
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Affiliation(s)
- Amna Qasim
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Tam T Doan
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Tam Dan Pham
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Dana Reaves-O'Neal
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Shagun Sachdeva
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children's Medical Center, The University of Texas at Austin, Austin, Texas.
| | - Ziyad Binsalamah
- The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Silvana Molossi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; The Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas.
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27
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Bigler MR, Stark AW, Giannopoulos AA, Huber AT, Siepe M, Kadner A, Räber L, Gräni C. Coronary CT FFR vs Invasive Adenosine and Dobutamine FFR in a Right Anomalous Coronary Artery. JACC Case Rep 2022; 4:929-933. [PMID: 35935159 PMCID: PMC9350890 DOI: 10.1016/j.jaccas.2022.06.009] [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: 04/13/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
We present the management of an anomalous coronary artery originating from the opposite sinus of Valsalva with comprehensive diagnostic workup including noninvasive coronary computed tomography (CT) derived fractional flow reserve (FFR) and invasive dobutamine-volume challenge-FFR/intravascular ultrasound. After surgical operation, treatment success was quantified by anatomical and functional analysis in postoperative CT. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Marius R. Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas A. Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Cardiology Department, University Hospital Zurich, Zurich, Switzerland
| | - Adrian T. Huber
- Department of Radiology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of 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
- Address for correspondence: Dr. Christoph Gräni, Department of Cardiology, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
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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.
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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
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29
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Prevalence, characteristics and management of anomalous coronary arteries in individuals undergoing cardiac computed tomography. Coron Artery Dis 2022; 33:593-595. [PMID: 35811557 DOI: 10.1097/mca.0000000000001165] [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: 11/03/2022]
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Koppel CJ, Verheijen DBH, Kiès P, Egorova AD, Lamb HJ, Voskuil M, Jukema JW, Koolbergen DR, Hazekamp MG, Schalij MJ, Jongbloed MRM, Vliegen HW. A comprehensive analysis of the intramural segment in interarterial anomalous coronary arteries using computed tomography angiography. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac031. [PMID: 35919578 PMCID: PMC9277063 DOI: 10.1093/ehjopen/oeac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
An anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS) with an interarterial course can be assessed using computed tomography angiography (CTA) for the presence of high-risk characteristics associated with sudden cardiac death. These features include a slit-like ostium, acute angle take-off, proximal luminal narrowing, and an intramural segment. To date, no robust CTA criteria exist to determine the presence of an intramural segment. We aimed to deduct new CTA parameters to distinguish an intramural course of interarterial ACAOS.
Methods and results
Twenty-five patients with an interarterial ACAOS (64% female, mean age 46 years, 88% right ACAOS) from two academic hospitals were evaluated. Inclusion criteria were the availability of a preoperative CTA scan (0.51 mm slice thickness) and peroperative confirmation of the intramural segment. Using multiplanar reconstruction of the CTA, the distance between the lumen of the aorta and the lumen of the ACAOS [defined as ‘interluminal space’ (ILS)] was assessed at 2 mm intervals along the intramural segment. Analysis showed a mean ILS of 0.69 ± 0.15 mm at 2 mm from the ostium. At the end of the intramural segment where the ACAOS becomes non-intramural, the mean ILS was significantly larger (1.27 ± 0.29 mm, P < 0.001). Interobserver agreement evaluation showed good reproducibility (intraclass correlation coefficient 0.77, P < 0.001). Receiver operator characteristic analysis demonstrated that at a cut-off ILS of <0.95 mm, an intramural segment can be diagnosed with 100% sensitivity and 84% specificity.
Conclusion
The ILS is introduced as a novel and robust CTA parameter to identify an intramural course of interarterial ACAOS. An ILS of <0.95 mm is indicative of an intramural segment.
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Affiliation(s)
- Claire J Koppel
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Diederick B H Verheijen
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Philippine Kiès
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center , Leiden , The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Dave R Koolbergen
- Department of Cardiothoracic Surgery, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Martin J Schalij
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
- Department of Anatomy & Embryology, Leiden University Medical Center , Leiden , The Netherlands
| | - Hubert W Vliegen
- Department of Cardiology, CAHAL, Center for Congenital Heart Disease Amsterdam-Leiden, Leiden University Medical Center , Leiden , The Netherlands
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Rodríguez Urteaga ZI, Murillo Pérez LE, Mendoza Paulini A, Talledo Paredes LS. [Prevalence of coronary anomalies detected by computed tomography at the Instituto Nacional Cardiovascular- INCOR]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:153-161. [PMID: 37284572 PMCID: PMC10241344 DOI: 10.47487/apcyccv.v3i2.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 06/08/2023]
Abstract
Objective : To determine the prevalence of coronary anomalies (CA) in patients evaluated by 64-detector computed tomography (CT) at the Instituto Nacional Cardiovascular in Peru between 2016 and 2020. Materials and methods Retrospective observational study, coronary artery CT scans of 1486 patients were performed on a 64-detector row CT scanner and reviewed in search for coronary anomalies. Results The prevalence of CA detected by CT was 4.71% (70 cases) of which 64.3% were male. Abnormalities of origin were the most frequent, of which the origin of a coronary artery from the opposite coronary sinus was the most common (48.6%), with the right coronary being the main anomalous artery (31%), and the main path was interarterial (31%). Anomalous origin of the left main coronary from the pulmonary artery was found in 5 patients. Among the anomalies of the intrinsic coronary arterial anatomy the most frequent was the double left anterior descending artery (10%). Coronary fistulas accounted for 11.4% of cases. Conclusions The prevalence of CA detected by 64-detector CT in a Peruvian institute was 4.71%. The most frequent coronary anomaly was the origin of the right coronary artery from the left coronary sinus with interarterial trajectory.
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Affiliation(s)
- Zoila I Rodríguez Urteaga
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Luis E Murillo Pérez
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Aurelio Mendoza Paulini
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
| | - Luisa S Talledo Paredes
- . Cardiología no invasiva. Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR. Lima, Perú. Cardiología no invasiva Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo" - INCOR Lima Perú
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Cao Y, Luo X, Liu Q, Zhou S. Chest pain caused by left coronary artery spasm in a patient with anomalous origin of right coronary artery. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:679-684. [PMID: 35753739 PMCID: PMC10929908 DOI: 10.11817/j.issn.1672-7347.2022.210292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 06/15/2023]
Abstract
Anomalous origin of coronary artery is rare and important reason of chest pain, syncope, and sudden death in young and middle-aged patients. This case reported a patient with interarterial anomalous right coronary artery and chest pain, which was confirmed to be the result of severe vasospasm of the proximal left anterior descending artery. The patient had reoccurred spontaneous chest pain and the dynamic ST segment and T wave changes at anterior walls. Coronary angiography confirmed left coronary artery spasm. Chest pain was controlled by diltiazem and isosorbide mononitrate. During 3 months of follow-up after discharge, the patient did not have chest pain anymore.
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Affiliation(s)
- Yuanyuan Cao
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Xiaolan Luo
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China
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D’Ascenzi F, Baggiano A, Cavigli L, Mandoli GE, Andreini D, Marallo C, Valente S, Focardi M, Cameli M, Pontone G. The role of cardiac computed tomography in sports cardiology: back to the future! Eur Heart J Cardiovasc Imaging 2022; 23:e481-e493. [DOI: 10.1093/ehjci/jeac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
In recent years, the role of pre-participation evaluation (PPE) in the prevention of sudden cardiac death in competitive athletes has become evident. Most physicians routinely supplement assessment by resting electrocardiogram with imaging techniques, such as echocardiography. The primary goal of imaging in the clinical assessment of competitive athletes is to exclude cardiovascular conditions associated with adverse outcomes. Cardiac computed tomography is emerging as an important technique for stratifying cardiovascular risk and assessing coronary artery disease (CAD), particularly in master athletes. Conversely, in young athletes, this technique has the best non-invasive coronary artery resolution and provides valuable details on coronary artery anatomy. Recent technical developments have brought about a dramatic reduction in radiation exposure, a major drawback of this diagnostic method; nowadays cardiac computed tomography may be performed at a dose of barely one millisievert. The present review provides a practical guide for the use of cardiac computed tomography in the PPE of competitive athletes, with a specific focus on its value for detecting congenital coronary anomalies and CAD in young and master athletes, respectively.
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Affiliation(s)
- Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, V.le M. Bracci 16, 53100 Siena, Italy
| | - Andrea Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, V.le M. Bracci 16, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, V.le M. Bracci 16, 53100 Siena, Italy
| | - Daniele Andreini
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Carmine Marallo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, V.le M. Bracci 16, 53100 Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, V.le M. Bracci 16, 53100 Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, V.le M. Bracci 16, 53100 Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, V.le M. Bracci 16, 53100 Siena, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Establishment of Standard Human Blood Vessel Model Based on Image Registration and Fitting Technology. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose
The blood vessel gives key information for pathological changes in a variety of diseases. In view of the crucial role of blood vessel structure, the present study aims to establish a digital human blood vessel standard model for diagnosing blood vessel-related diseases.
Methods
The present study recruited eight healthy volunteers, and reconstructed their bilateral upper extremity arteries according to CTA. The reconstructed vessels were segmented, registered, and merged into a bunch. After being cut by continuous cut planes, the dispersion of the blood vessel bunches on each cut plane were calculated.
Results
The results demonstrated that the middle segment of the brachial artery, the proximal segment of the ulnar artery, and the middle and distal segments of the radial artery had a low degree of dispersion. A standard blood vessel model was finally established by the integral method using the low-dispersion segments above. The accuracy of the standard blood vessel model was also verified by an actual contralateral vessel, which revealed that the deviation between the model and the actual normal contralateral brachial artery was relatively small.
Conclusion
The structure of the model was highly accordant with the real ones, which can be of great help in evaluating the blood vessel changes in blood vessel-related diseases, bone and soft-tissue tumors, and creating accurate surgical plans.
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Kim JY, Hong YJ, Han K, Lee S, Kim YJ, Choi BW, Lee HJ. Evaluation of the Ostium in Anomalous Origin of the Right Coronary Artery with an Interarterial Course Using Dynamic Cardiac CT and Implications of Ostial Findings. Korean J Radiol 2022; 23:172-179. [PMID: 35029074 PMCID: PMC8814709 DOI: 10.3348/kjr.2021.0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the ostium of right coronary artery of anomalous origin from the left coronary sinus (AORL) with an interarterial course throughout the cardiac cycle on CT and analyze the clinical significance of the ostial findings. MATERIALS AND METHODS From January 2011 to December 2015, 68 patients (41 male, 57.3 ± 12.1 years) with AORL with an interarterial course and retrospective cardiac CT data were included. AORL was classified as high or low ostial location based on the pulmonary annulus in the diastolic and systolic phases on cardiac CT. In addition, the height, width, height/width ratio, area, and angle of the ostium were measured in both cardiac phases. After cardiac CT, patients were followed until December 31, 2020 for major adverse cardiac events (MACE). Clinical and CT characteristics associated with MACE were explored using Cox regression analysis. RESULTS During a median follow-up period of 2071 days (interquartile range, 1180.5-2747.3 days), 13 patients experienced MACE (19.1%, 13/68). Seven (10.3%, 7/68) had the ostial location change from high in the diastolic phase to low in the systolic phase. In the univariable analysis, younger age (hazard ratio [HR] = 0.918, p < 0.001), high ostial location (HR = 4.008, p = 0.036), larger height/width ratio (HR = 5.621, p = 0.049), and smaller ostial angle (HR = 0.846, p = 0.048) in the systolic phase were significant predictors of MACE. In multivariable cox regression analysis, younger age (adjusted HR = 0.917, p = 0.002) and high ostial location in the systolic phase (adjusted HR = 4.345, p = 0.026) were independent predictors of MACE. CONCLUSION The ostial location of AORL with an interarterial course can change during the cardiac cycle, and high ostial location in the systolic phase was an independent predictor of MACE.
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Affiliation(s)
- Jin-Young Kim
- Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suji Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Lee HJ, Kim JY. Coronary Artery Anomaly, What Radiologist Should Know? JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:84-101. [PMID: 36237368 PMCID: PMC9238192 DOI: 10.3348/jksr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/15/2022]
Abstract
심장 전산화단층촬영(이하 CT)은 현재 관상동맥기형을 진단하고, 평가하는 가장 정확한 진단 도구로 자리매김하였으며, 심장 CT 촬영 건수가 증가함에 따라 관상동맥기형을 종종 관찰할 수 있다. 본 종설은 관상동맥기형에서 영상의학과 의사들이 꼭 알아야 할 대표적인 기형의 CT 소견들에 대해 다루었다. 관상동맥기형의 종류를 3부분 즉, 기시부, 동맥 내, 그리고 연결 부위로 나누어 설명하였으며, 임상에서 볼 수 있는 대표적인 기형들 중심으로 다루었다. 특히 혈역학적 이상을 유발하거나, 급사의 위험이 있는 기형들의 CT상 위험한 해부학적 소견에 대해서는 자세히 기술하였다.
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Affiliation(s)
- Hyun Jin Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Hammami R, Ben Mrad I, Bahloul A, Charfeddine S, Gribaa R, thabet H, Allouche E, Ben Abdessalem A, Hassine M, Abid L, Kammoun S, Amor HIH. Angioplasty of Anomalous Coronaries Arising from the Opposite Sinus with an Interarterial Course, is it Safe? J Saudi Heart Assoc 2021; 33:296-305. [PMID: 35083121 PMCID: PMC8754440 DOI: 10.37616/2212-5043.1280] [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: 07/06/2021] [Revised: 08/05/2021] [Accepted: 09/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The coronary artery with an interarterial course CAIAC is the most threatening coronary anomaly, especially if it concerns the left coronary. Percutaneous coronary intervention PCI is scarcely described given its low prevalence and lack of long-term outcome data. Therefore, we assessed through this case series the feasibility and safety of PCI in this population. METHODS This is an observational multicentric study including patients with CAIAC arising from the opposite sinus of Valsalva. The primary endpoints were immediate angiographic success and target lesion revascularization. RESULTS During the period of the study, we performed 27235 PCI in six Cath labs, 26 procedures concerning abnormal coronaries including 12 with CAIAC. The median age was 57 years extremes: 43-78 with male predominance 1:11. Anomalous coronary artery was Right coronary artery RCA in eight patients, Left main LM in three patients, and left anterior descending LAD in one patient. The stenosis was located in all cases in proximal segments beyond the inter-arterial course proximal LAD, the superior genius of the RCA, or the proximal segment of mid-RCA. Five patients showed slit-like ostium and all have an angle take-off <45° on CT scan. After a median follow-up of 24 months, four subjects presented target lesion revascularization TLR, all were initially treated with either a bare-metal stent or with balloons. CONCLUSIONS PCI of patients with CAIAC is feasible and appears safe. The operator should carefully analyze the angiogram before PCI to choose the appropriate guiding catheter and should be acquainted with the different techniques for improving backup.
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Affiliation(s)
- Rania Hammami
- Cardiology Department, Hedi Chaker Hospital, Sfax,
Tunisia
- Research Unit RU 17ES37, University of Medicine, Sfax University,
Tunisia
| | | | - Amine Bahloul
- Cardiology Department, Hedi Chaker Hospital, Sfax,
Tunisia
| | | | - Rym Gribaa
- Cardiology Department, Sahloul Hospital, Sousse,
Tunisia
| | - Houssem thabet
- Cardiology Department, Sahloul Hospital, Sousse,
Tunisia
| | - Emna Allouche
- Cardiology Department, Charles Nicolles Hospital, Tunis,
Tunisia
| | | | - Majed Hassine
- Cardiology Department, Fattouma Bourguiba Hospital, Monastir,
Tunisia
| | - Leila Abid
- Cardiology Department, Hedi Chaker Hospital, Sfax,
Tunisia
- Research Unit RU 17ES37, University of Medicine, Sfax University,
Tunisia
| | - Samir Kammoun
- Cardiology Department, Hedi Chaker Hospital, Sfax,
Tunisia
- Research Unit RU 17ES37, University of Medicine, Sfax University,
Tunisia
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Deng L, Li T, Ling Y, Tang M. Tetralogy of fallot in addition to anomalous aortic origin of a coronary artery in a 1-year-old boy: a case report. BMC Surg 2021; 21:384. [PMID: 34717598 PMCID: PMC8557548 DOI: 10.1186/s12893-021-01380-3] [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: 05/24/2021] [Accepted: 10/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart disease, characterized by the coronary artery inappropriately originates from the aorta. It is usually classified according to the sinus where the coronary artery arises from, while anomalous origin of the right coronary being the most common type. Case presentation In this case report, we described a rare case of Tetralogy of Fallot (TOF) in a 1-year-old boy, who also had the anomalous right coronary artery that originated from the left coronary sinus without an intramural segment. Besides TOF repair, lateral pulmonary translocation was undertaken in order to avoid risks of myocardial ischemia. Conclusion We successfully completed a one-stage operation consisting of TOF repair and pulmonary artery translocation in a 1-year-old boy. We advocated early operation of pulmonic translocation for AAOCA patients without an intramural segment instead of unroofing procedure.
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Affiliation(s)
- Lihua Deng
- Department of Intensive Care Unit, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tiange Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Menglin Tang
- Department of Intensive Care Unit, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases. Sci Rep 2021; 11:18666. [PMID: 34548524 PMCID: PMC8455645 DOI: 10.1038/s41598-021-97917-w] [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: 05/24/2021] [Accepted: 08/26/2021] [Indexed: 11/08/2022] Open
Abstract
Anomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.
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Abstract
Coronary artery anomalies (CAAs) are a group of congenital conditions characterized by abnormal origin or course of any of the 3 main epicardial coronary arteries. Although CAAs have been identified as a common underlying condition in young athletes with sudden cardiac death, the widespread use of invasive and noninvasive coronary imaging has led to increased recognition of CAAs among adults. CAAS are often discovered as an incidental finding during the diagnostic workup for ischemic heart disease. The clinical correlates and prognostic implication of CAAs remain poorly understood in this context, and guideline-recommended therapeutic choices are supported by a low level of scientific evidence. Several studies have examined whether assessment of CAA-related myocardial ischemia can improve risk stratification in these patients, suggesting that multimodality imaging and functional tests may be key in the management of CAAs. The aim of this review is to outline definitions, classification, and epidemiology of the most relevant CAAs, highlighting recent advances and the potential impact of multimodality evaluation, and to discuss current therapeutic opportunities.
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Affiliation(s)
- Francesco Gentile
- Cardiology Division, Pisa University Hospital, Italy (F.G., V.C., R.D.C.)
| | | | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital, Italy (F.G., V.C., R.D.C.).,Fondazione Villa Serena per la Ricerca, Città Sant'Angelo, Pescara, Italy (R.D.C.)
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Affiliation(s)
- Stephen Dolgner
- Adult Congenital Heart Program, Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA .,Coronary Anomalies Program, Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Edward Hickey
- Adult Congenital Heart Program, Department of Surgery, Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Silvana Molossi
- Coronary Anomalies Program, Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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42
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Adam EL, Generoso G, Bittencourt MS. Anomalous Coronary Arteries: When to Follow-up, Risk Stratify, and Plan Intervention. Curr Cardiol Rep 2021; 23:102. [PMID: 34196813 DOI: 10.1007/s11886-021-01535-x] [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: 05/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Coronary artery anomalies are a diverse group of entities, ranging from benign variations of normal anatomy to life-threatening conditions. There is, however, no universal consensus in their classification, risk stratification, and management. The aim of this review is to develop a straightforward clinical approach for the assessment and care of patients with anomalous coronary arteries. RECENT FINDINGS Autopsy series and population screening studies have recently provided useful clinical data on the prevalence and outcomes of coronary anomalies. Also, findings on coronary computed tomography angiography, magnetic resonance imaging, and invasive angiography, enriched with fractional flow reserve and intravascular ultrasound, have allowed identification of several high-risk features associated with specific coronary anomalies. Management of patients with anomalous coronary arteries requires an individualized approach based on clinical, physiological, and anatomic features. High-quality studies are paramount for further development of this fascinating field.
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Affiliation(s)
| | - Giuliano Generoso
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcio Sommer Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
- DASA, Sao Paulo, Brazil.
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43
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Nagashima K, Hiro T, Fukamachi D, Okumura Y, Watanabe I, Hirayama A, Tanaka M, Tanaka T, Takamisawa I, Taguchi I, Sato A, Aonuma K, Fukamizu S, Nakada A, Watanabe A, Amioka N, Suzuki Y, Matsumoto N, Koizumi J, Kumagai K, Naya M, Higuchi Y, Naito Y, Masuyama T, Kawamura M, Tsunoda R, Suzuki S, Ishii H, Murohara T, Shimizu T, Takeishi Y, Shiina K, Yamashita J, Imamura T, Sumitomo N, Noguchi T, Aso T, Furukawa K, Yamauchi Y, Okishige K, Sakata K, Yamagishi M, Shimizu S, Ohno M, Sugano T, Matsumura K, Matsumoto K, Ozaki K, Hayashidani S, Meno H, Iwata A, Higuma T, Tomita H, Yoshino H, Taniai S, Shishido K, Murakami M, Negishi K, Nii M, Wakatsuki D, Suzuki H, Motoike Y, Ozaki Y, Nakazato J, Hayashi H, Higuchi S, Shoda M. Anomalous origin of the coronary artery coursing between the great vessels presenting with a cardiovascular event (J-CONOMALY Registry). Eur Heart J Cardiovasc Imaging 2021; 21:222-230. [PMID: 31185091 DOI: 10.1093/ehjci/jez076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/28/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Anomalous origin of the coronary artery (AOCA) with an inter-arterial course (IAC) between the great vessels poses a risk for a life-threatening cardiovascular event. We assessed, in a registry-based study, the clinical features, treatment strategies, and prognoses of life-threatening cardiovascular events ensuant to AOCA. METHODS AND RESULTS Included were 65 AOCA patients (48 men/17 women, aged 41 ± 23 years) from 40 clinical centres who had experienced sudden cardiac arrest (SCA) (n = 30), acute myocardial infarction (AMI) (n = 5), angina (n = 23), or syncope (n = 7). The anomalous vessel was the right coronary artery in 72% of patients and left coronary artery in 28%; the ostium was slit-like in 42%. Coronary luminal narrowing ≥75% was absent in patients with SCA or syncope (86% and 57%, respectively), but occlusion or narrowing was seen in those with AMI (100%) or angina (52%). Age ≤40 years, male sex, sporting activity, absence of prodromal symptoms, acutely angled (≤30°) take-off from the aorta, and absence of luminal narrowing of the IAC segment were associated with SCA in this patient group. Coronary vasospasm was inducible in 12 of 17 patients without coronary narrowing. Management included surgical revascularization (n = 26) percutaneous coronary intervention (n = 9), and medical treatment (n = 26). Four SCA patients died while hospitalized; no others died during the median 5.0 (range, 1.8-7.0)-year follow-up period. CONCLUSIONS In patients with AOCA, age ≤40 years, male sex, sporting activity, and an acute take-off angle appear to be risk factors for SCA. Appropriate management can be beneficial. Confirmation in a large-scale study is warranted.
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Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Daisuke Fukamachi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Masashi Tanaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Tomofumi Tanaka
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama 343-8555, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Akihiro Nakada
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo 150-0013, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Naofumi Amioka
- Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Yasuyuki Suzuki
- Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
| | - Naoya Matsumoto
- Department of Cardiology, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, 9-1, Uchimaru, Morioka city, Iwate 020-8505, Japan
| | - Kazuya Kumagai
- Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, 9-1, Uchimaru, Morioka city, Iwate 020-8505, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Yoshiharu Higuchi
- Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka 543-0035, Japan
| | - Yoshiro Naito
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Mitsuharu Kawamura
- Division of Cardiology, School of Medicine, Showa University, 1-5-8, Hatanodai Shinagawa, Tokyo 142-8555, Japan
| | - Ryusuke Tsunoda
- Department of Cardiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto 861-8520, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Takeshi Shimizu
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima City 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima City 960-1295, Japan
| | - Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Tomohiko Imamura
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-City, Saitama 350-1298, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-City, Saitama 350-1298, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Toshihide Aso
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan
| | - Kojiro Furukawa
- Department of Cardiovascular Surgery, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Yasuteru Yamauchi
- Heart Center, Yokohama-City Bay Red Cross Hospital, 3-12-1, Shinnyamashita, Naka-ku, Yokohama-shi, Kanagawa 231-0801, Japan
| | - Kaoru Okishige
- Heart Center, Yokohama-City Bay Red Cross Hospital, 3-12-1, Shinnyamashita, Naka-ku, Yokohama-shi, Kanagawa 231-0801, Japan
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Graduate School of Medicine, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Graduate School of Medicine, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Shigeo Shimizu
- Department of Cardiology, National Hospital Organization, National Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo 190-0014, Japan
| | - Masakazu Ohno
- Department of Cardiology, National Hospital Organization, National Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo 190-0014, Japan
| | - Teruyasu Sugano
- Department of Medical Science and Cardiorenal Medicine, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Koichiro Matsumura
- Department of Cardiology, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi 570-8507, Japan
| | - Kensuke Matsumoto
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, 2-5-1, Nakai-cho, Kita-ku, Okayama 700-0804, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Niigata 951-8514, Japan
| | - Shunji Hayashidani
- Division of Cardiology, Fukuoka Red Cross Hospital, 3-1-1 Okusu Minamiku, Fukuoka-shi, Fukuoka 815-8555, Japan
| | - Hiroshi Meno
- Division of Cardiology, Fukuoka Red Cross Hospital, 3-1-1 Okusu Minamiku, Fukuoka-shi, Fukuoka 815-8555, Japan
| | - Atsushi Iwata
- Department of Cardiology, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Takumi Higuma
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Seiichi Taniai
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan
| | - Masato Murakami
- Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan
| | - Koji Negishi
- Department of Cardiology, Yokohama Municipal Citizens' Hospital, 56 Okasawa-cho, Hodogaya-ku, Yokohama City, Kanagawa 240-8555, Japan
| | - Masaki Nii
- Shizuoka Children's Hospital, 860 Urusiyama, Aoi-ku, Shizuoka 420-8660, Japan
| | - Daisuke Wakatsuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa 227-8501, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa 227-8501, Japan
| | - Yuji Motoike
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Jun Nakazato
- Department of Cardiovascular Medicine, Okinawa Prefectural Chubu Hospital, 281 Miyazato, Uruma-city, Okinawa 904-2293, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Meijer FMM, Kiès P, Verheijen DBH, Vliegen HW, Jongbloed MRM, Hazekamp MG, Lamb HJ, Egorova AD. Computed Tomography Derived Coronary Triangulated Orifice Area-Deduction of a New Parameter for Follow-up After Surgical Correction of Anomalous Aortic Origin of Coronary Arteries and Call for Validation. Front Cardiovasc Med 2021; 8:668503. [PMID: 34250037 PMCID: PMC8263932 DOI: 10.3389/fcvm.2021.668503] [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: 02/16/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva is a rare congenital abnormality. Computed tomography angiography (CTA) is primarily used as a diagnostic tool to evaluate the anatomy and identify potentially malignant AAOCA variants. Limited data is available on the role of CTA during postoperative follow-up. We aimed to develop an objective CTA derived parameter for diagnostic evaluation and follow-up after surgical correction of AAOCA and correlate the anatomical features to the postoperative outcome. Methods: All consecutive patients who underwent surgical repair of AAOCA from 2001 to 2018 and had pre and postoperative CTA imaging available were included. A retrospective analysis of the pre- and postoperative CTA and the outcomes was performed. The origin and course of the anomalous coronary artery and the ostial dimensions were evaluated and correlated with restenosis of operated coronary artery. To allow an accurate evaluation of the effective orifice area at diagnosis and after surgical repair we deduce and propose a new parameter—the coronary triangulated orifice area (CTOA). Results: Out of the 54 patients who underwent surgical treatment for AAOCA, 11 fulfilled the inclusion criteria. The median follow-up was 19 months [IQR 3;42]. The mean age at surgery was 41 ± 16 years, with six patients (55%) being male. Postoperatively, the angle between the proximal coronary artery and the aortic wall increased from 20 ± 5° to 28 ± 9° (p < 0.01) and ostial diameter in the transversal plane increased from 4.1 ± 2.5 mm to 6.2 ± 2.7 mm (p < 0.01). The median CTOA increased significantly from 1.6 mm2 [IQR 0.9;4.9] to 5.5 mm2 [IQR 3;11.8] (p < 0.005). During follow-up, in three patients a restenosis of the operated coronary artery was suspected. In these patients, the CTOA only showed a limited postoperative increase of ≤ 1.4 mm2. Conclusions: CTA can play an important role in the evaluation of the pre- and postoperative anatomy in AAOCA patients. CTOA may be of use in conjunction with the acute angle take-off and ostial diameter order to comprehensively evaluate the operated ostium after unroofing or patch angioplasty.
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Affiliation(s)
- Fleur M M Meijer
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Diederick B H Verheijen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden, Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Courand PY, Bozio A, Ninet J, Boussel L, Bakloul M, Galoin-Bertail C, Metton O, Mitchell J, de Montclos TP, Walton C, Di Filippo S. Diagnosis and treatment of anomalous aortic origin of coronary artery: A twenty-year retrospective study of experience and decision-making in children and young adults. Int J Cardiol 2021; 337:54-61. [PMID: 33945804 DOI: 10.1016/j.ijcard.2021.04.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Anomalous aortic origin of a coronary artery, particularly in the presence of inter-arterial course between the great arteries, has been found to be associated with sudden death in young people. METHODS This study reports a single-center experience in the management of anomalous aortic origin of a coronary artery, with or without inter-arterial course, by focusing specifically on presentation, diagnosis, and patient outcome. RESULTS From March 1993 to February 2018, 100 patients (70 males) were diagnosed with anomalous aortic origin of a coronary artery, including 27 left coronary artery from the right sinus, 60 right coronary artery from the left sinus, and 13 other anomalies. Patients with inter-arterial course between the great arteries presented more frequently with syncope and/or sudden death compared to patients without (23.4% vs. 0%, p = 0.026). Diagnosis was reached using first-line transthoracic echocardiography in 65% of cases. Surgical repair was performed in 61 patients (61%). All operated patients (60 direct implantations, 1 unroofing) had been diagnosed with inter-arterial course between the great arteries, and were asymptomatic at a mean (±SD) postoperative follow-up of 4.9 ± 5.3 years. CONCLUSIONS An inter-arterial course of the anomalous right or left coronary arteries arising from the opposite sinus is associated with life-threatening events. Direct reimplantation of coronary artery is reliable, and should be discussed even in asymptomatic patients.
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Affiliation(s)
- Pierre-Yves Courand
- Fédération de cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Claude Bernard Lyon 1, France
| | - Andre Bozio
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Jean Ninet
- Service de chirurgie cardiaque, Hôpital Louis Pradel Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Loic Boussel
- Service de radiologie, Hôpital de la Croix-Rousse, Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Mohamed Bakloul
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Claire Galoin-Bertail
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Olivier Metton
- Service de chirurgie cardiaque, Hôpital Louis Pradel Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Julia Mitchell
- Service de chirurgie cardiaque, Hôpital Louis Pradel Hospices civils de Lyon, 69317 Lyon cedex 04, France
| | - Thomas Perouse de Montclos
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Camille Walton
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France
| | - Sylvie Di Filippo
- Service de cardiologie congénitale, Hôpital Louis Pradel, Hospices civils de Lyon, 69317 Lyon cedex 04, France; Université Claude Bernard Lyon I, 69677 Lyon, France.
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46
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Narula J, Chandrashekhar Y, Ahmadi A, Abbara S, Berman DS, Blankstein R, Leipsic J, Newby D, Nicol ED, Nieman K, Shaw L, Villines TC, Williams M, Hecht HS. SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2021; 15:192-217. [PMID: 33303384 PMCID: PMC8713482 DOI: 10.1016/j.jcct.2020.11.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Y Chandrashekhar
- University of Minnesota and VA Medical Center, Minneapolis, MN, USA
| | - Amir Ahmadi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Ron Blankstein
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - David Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Edward D Nicol
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Leslee Shaw
- New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
| | - Michelle Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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47
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Cong M, Zhao H, Dai S, Chen C, Xu X, Qiu J, Qin S. Transient numerical simulation of the right coronary artery originating from the left sinus and the effect of its acute take-off angle on hemodynamics. Quant Imaging Med Surg 2021; 11:2062-2075. [PMID: 33936987 DOI: 10.21037/qims-20-125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background An anomalous origin of the right coronary artery from the left coronary artery sinus is usually characterized by an acute take-off angle. Most affected patients have no clinical symptoms; however, some patients have decreased blood flow into the right coronary artery during exercise, which can lead to symptoms such as myocardial ischemia. Most researchers who have studied an anomalous origin of the right coronary artery from the left coronary artery sinus have done so through clinical cases. In this study, we used numerical simulation to evaluate the hemodynamics of this condition and the effect of an acute take-off angle on hemodynamic parameters. We expect that the results of this study will help in further understanding the clinical symptoms of this anomaly and the hemodynamic impact of an acute take-off angle. Methods Three-dimensional models were reconstructed based on the computed tomography images from 16 patients with a normal right coronary artery and 26 patients with an anomalous origin of the right coronary artery from the left coronary artery sinus. A numerical simulation of a two-way fluid-structure interaction was executed with ANSYS Workbench software. The blood was assumed to be an incompressible Newtonian fluid, and the vessel was assumed to be an isotropic, linear elastic material. Hemodynamic parameters and the effect of an acute take-off angle were statistically analyzed. Results During the systolic period, the wall pressure in the right coronary artery was significantly reduced in patients with an anomalous origin of the right coronary artery (t =1.32 s, P=0.0001; t =1.34-1.46 s, P<0.0001). The wall shear stress in the abnormal group was higher at the beginning of the systolic period (t =1.24 s, P=0.0473; t =1.26 s, P=0.0193; t =1.28 s, P=0.0441). The acute take-off angle was smaller in patients with clinical symptoms (27.81°±4.406°) than in patients without clinical symptoms (31.86°±2.789°; P=0.017). In the symptomatic group, pressure was negatively correlated with the acute take-off angle (P=0.0185-0.0341, r=-0.459 to -0.4167). Conclusions This study shows that an anomalous origin of the right coronary artery from the left coronary artery sinus causes changes in hemodynamic parameters, and that an acute take-off angle in patients with this anomaly is associated with terminal ischemia of the right coronary artery.
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Affiliation(s)
- Mengyang Cong
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao, China
| | - Huihui Zhao
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China.,Center for Medical Engineer Technology Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
| | - Shun Dai
- Department of Radiology, Shanghai Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanzhi Chen
- Department of Radiology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingming Xu
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Tai'an, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China.,Center for Medical Engineer Technology Research, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
| | - Shengxue Qin
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao, China
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Blomjous MSH, Budde RPJ, Bekker MWA, Kauling RM, Cuypers JAAE, van den Bosch AE, Roos-Hesselink JW, Hirsch A. Clinical outcome of anomalous coronary artery with interarterial course in adults: Single-center experience combined with a systematic review. Int J Cardiol 2021; 335:32-39. [PMID: 33831507 DOI: 10.1016/j.ijcard.2021.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Anomalous coronary artery originating from the opposite sinus of Vasalva with interarterial course (ACAOS-IAC) is associated with sudden cardiac death (SCD) in young athletes. If identified in adulthood prognosis is usually more benign, resulting in a dilemma regarding revascularization. METHODS This is a retrospective observational single-center study, including adults with ACAOS-IAC. Medical records between 2012 and 2019 were reviewed for management approach, mortality, cardiac death and coronary related adverse events. Coronary computed tomographic angiography (CCTA) were reviewed. We provide a literature review in regard to clinical outcome. RESULTS We identified 40 patients with ACAOS-IAC (mean age 51). Presentation was acute in 7/40 (18%). Ischemia detection with single photon emission tomography (SPECT), cardiac magnetic resonance (CMR) or dobutamine stress echocardiography were performed in 25/40 (63%) patients. Ischemia in the vascular territory of the anomaly was present in 2/25 (8%). In 39/40 (98%) patients were treated expectative. During median follow-up of 2.7 years (IQR 1.5-5.3) no cardiovascular death was observed. Mortality occurred in 1/40 (3%) and coronary related adverse events in 2/40 (5%). We identified 20 studies describing 1194 patients. Revascularization was performed in 376/1154 (32.6%) patients. Mortality stratified for clinical management was 23/431 (5.3%) in the non-revascularization versus 16/253 (6.3%) in the revascularization group during 4.0 years follow-up (weighted median). Cause of death was cardiovascular in 10/596 (1.7%) in 4.2 years (weighted median) follow up. CONCLUSIONS Both revascularization and non-invasive management have good prognosis in adults with ACAOS-IAC during early follow up. There is need for guidelines and long-term surveillance.
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Affiliation(s)
- Maurits S H Blomjous
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Margreet W A Bekker
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert M Kauling
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alexander Hirsch
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Kumar P, Bhatia M. Coronary Artery Disease Reporting and Data System: A Comprehensive Review. J Cardiovasc Imaging 2021; 30:1-24. [PMID: 34080334 PMCID: PMC8792723 DOI: 10.4250/jcvi.2020.0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 11/25/2022] Open
Abstract
The Coronary Artery Disease Reporting and Data System (CAD-RADS) is a standardized reporting method for coronary computed tomography angiography (CCTA). It summarizes the findings of CCTA in 6 categories ranging from CAD-RADS 0 (complete absence of coronary artery disease) to CAD-RADS 5 (total occlusion of at least one vessel). It is applied on per patient basis for the highest grade of the stenotic lesion. The CAD-RADS also provides category-specific treatment recommendations, helping patient management. The main objectives of the CAD-RADS are to improve the consistency in reporting, facilitate the communication between interpreting and referring clinicians, recommend the best course of patient management, and produce consistent data for quality improvement, research and education. However, CAD-RADS has many limitations, resulting into the misclassification of the observed findings, misinterpretation of the final category, and misguidance for the treatment based upon the single score. In this review, the authors discuss the CAD-RADS categories and modifiers, along with the strengths and limitations of this new classification system.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India.
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India.,Cardiac Imaging, Cardiological Society of India, Kolkata, India.,International Regional Committee, India Chapter, Society of Cardiovascular Computed Tomography, Arlington, VA, USA
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Chaosuwannakit N, Makarawate P. Diagnosis and prognostic significance of anomalous origin of coronary artery from the opposite sinus of Valsalva assess by dual-source coronary computed tomography angiography. IJC HEART & VASCULATURE 2021; 32:100723. [PMID: 33553570 PMCID: PMC7851334 DOI: 10.1016/j.ijcha.2021.100723] [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: 01/04/2021] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 10/26/2022]
Abstract
Background Clinically recognized coronary anomalies in adults are infrequent and characteristically establish on autopsy. The clinical importance coronary arteries consist of those with anomalous origin of the coronary artery from the opposite sinus of Valsalva (ACAOS) with an inter-arterial course (IAC). We have endeavored to attribute variable risk based on morphological appearances of the ACAOS by dual-source coronary computed tomography angiography (DSCTA). Material and methods ACAOS patients who undergoing DSCTA over a 5-year period were identified and assess morphologic characteristics. Medical records were reviewed for major adverse cardiovascular events (MACEs). Results A total of 1126 patients who undergoing DSCTA were evaluated. Twenty-four patients with ACAOS with IAC were recognized with a prevalence of 2.1% of study population. Twenty patients had anomalous origin of right coronary artery from left sinus of Valsalva (RCA-LSV) and 4 patients had anomalous origin of left coronary from right sinus of Valsalva (LCA-RSV). A significant increased prevalence of MACEs in were observed in intramural, slit-like and high inter-arterial course morphology group. Median follow-up time was 13 months (IQR 3-18 months). During follow-up 2 died, 4 had PCI, 13 had myocardial infarction and 7 had surgical treatment. Conclusions Intramural, slit-like and high type inter-arterial course morphology of ACAOS with IAC are high risk features for MACEs which can be identified by DSCTA.
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Affiliation(s)
| | - Pattarapong Makarawate
- Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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