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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries: A State-of-the-Art Approach. Card Electrophysiol Clin 2024; 16:51-69. [PMID: 38280814 DOI: 10.1016/j.ccep.2023.09.007] [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] [Indexed: 01/29/2024]
Abstract
Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Tam Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries: A State-of-the-Art Approach. Interv Cardiol Clin 2024; 13:51-70. [PMID: 37980067 DOI: 10.1016/j.iccl.2023.09.001] [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] [Indexed: 11/20/2023]
Abstract
Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
| | - Tam Doan
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA
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Kohlsaat K, Gauvreau K, Beroukhim R, Newburger JW, Quinonez L, Nathan M. Trends in surgical management of anomalous aortic origin of the coronary artery over 2 decades. JTCVS OPEN 2023; 16:757-770. [PMID: 38204671 PMCID: PMC10774946 DOI: 10.1016/j.xjon.2023.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 01/12/2024]
Abstract
Objective To evaluate outcomes of patients undergoing surgery for anomalous aortic origin of the coronary artery (AAOCA) at a tertiary care center and determine the influences of a coronary artery program on management strategies and outcomes. Methods This retrospective review of consecutive surgical patients who had isolated AAOCA at a tertiary care center between August 1, 1999, and October 31, 2022, compared patient characteristics, interventional timing, and surgical strategies before and after program inception in 2018. Comparisons between time periods and anatomical subgroups were performed using Fisher exact and Wilcoxon rank-sum tests. Results Of 149 surgical AAOCA patients, 102 (69%) had AAO of the right coronary artery. Compared with AAO of the left coronary artery (AAOLCA), AAO of the right coronary artery (AAORCA) was associated with greater athletic participation (intramural, varsity, and college-level) (74% vs 43%; P < .001) and preoperative functional imaging (72% vs 49%; P = .01), but were less likely to have ischemic changes on functional imaging (5% vs 23%; P = .03) or any postoperative complications (7% vs 19%; P = .04). Moderate or greater aortic insufficiency occurred postoperatively in 1 (1%) of AAORCA and 1 (3%) of AAOLCA patients. After the coronary artery program inception, there was an increase among patients with AAOCA undergoing preoperative computed tomography angiography (pre-2018: 39 out of 98 [40%] vs post-2018: 48 out of 51 [94%]; P < .001) and a decrease in isolated AAOCA unroofing procedures performed (30 [31%] vs 5 [10%]; P = .004). Conclusions Surgical management of AAOCA evolved over time, and can be achieved with low instance of postoperative aortic insufficiency. Establishment of a coronary artery program has streamlined care.
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Affiliation(s)
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
- Department of Biostatistics, Harvard School of Public Health, Boston, Mass
| | - Rebecca Beroukhim
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Jane W. Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Luis Quinonez
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
- Department of Surgery, Harvard Medical School, Boston, Mass
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Zeppilli P, Bianco M, Gervasi SF, Cammarano M, Monti R, Sollazzo F, Modica G, Morra L, Nifosì FM, Palmieri V. Congenital coronary artery anomalies in sports medicine. Why to know them. Clin Cardiol 2023; 46:1038-1048. [PMID: 37432696 PMCID: PMC10540032 DOI: 10.1002/clc.24084] [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: 04/11/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
The anomalous origin of a coronary artery (AOCA) is a challenging topic, due to its rarity, the complexity of the pathophysiological aspects, the clinical presentation (often silent), the difficulty of diagnosis, and the potential risk of causing acute cardiovascular events up to sudden cardiac death, particularly when triggered by heavy physical exercise or sport practice. Increasing interest in sport medical literature is being given to this topic. This paper reviews current knowledge of AOCAs in the specific context of the athletic setting addressing epidemiological and pathophysiological aspects, diagnostic work-up, sports participation, individual risk assessment, therapeutic options, and return to play decision after surgery.
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Affiliation(s)
- Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Massimiliano Bianco
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Salvatore F. Gervasi
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Michela Cammarano
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Riccardo Monti
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Fabrizio Sollazzo
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Gloria Modica
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Lorenzo Morra
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Francesco M. Nifosì
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCSCatholic UniversityRomeItaly
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Molossi S, Doan T, Sachdeva S. Anomalous Coronary Arteries. Cardiol Clin 2023; 41:51-69. [DOI: 10.1016/j.ccl.2022.08.005] [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: 11/10/2022]
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Patlolla SH, Stephens EH, Schaff HV, Anavekar NS, Miranda WR, Julsrud PR, Dearani JA. Outcomes of a protocolized approach for surgical unroofing of intramural anomalous aortic origin of coronary artery in children and adults. J Thorac Cardiovasc Surg 2022; 165:1641-1650. [PMID: 36690526 DOI: 10.1016/j.jtcvs.2022.11.037] [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: 05/18/2022] [Revised: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Management of anomalous aortic origin of coronary arteries has been variable, and limited data are available on early and late outcomes. METHODS We report a single institution's experience with a protocolized approach to 148 consecutive patients who underwent surgical unroofing of intramural anomalous aortic origin of coronary arteries (June 2003 to December 2020). The management algorithm included preoperative and postoperative cross-sectional and echocardiographic imaging, exercise testing, and a standardized operative technique. RESULTS The median age of the cohort was 44.4 years (range, 4 months to 83 years); 130 patients had an anomalous right coronary artery, and 19 patients had an anomalous left coronary artery. Surgical unroofing was an isolated procedure in 118 patients (80%) and a concomitant procedure in 30 patients (20.3%). There were 2 (1%) early deaths; both were reoperations for aortic root or valve replacement. Over a median follow-up of 9.5 (interquartile range, 5-12.3) years, there were 5 late deaths, 3 due to noncardiac causes and 2 due to unknown cause. Late survival after anomalous aortic origin of coronary arteries repair at 10 and 15 years was 94.5% and 94.5%, respectively. There were no early or late deaths in the pediatric cohort with a median follow-up of 10.9 years (interquartile range, 6.9-12.1). At a median clinical follow-up of 3.9 years (interquartile range, 1.1-9.5), 36 patients had chest pain but none with evidence of ischemia related to the unroofing. CONCLUSIONS Surgical unroofing of anomalous aortic origin of coronary arteries can be performed safely with low early mortality, even in the setting of concomitant procedures. Late survival is excellent, with the vast majority being symptom free.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Elizabeth H Stephens
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | | | | | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn.
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Bonilla-Ramirez C, Molossi S, Sachdeva S, Reaves-O'Neal D, Masand P, Mery CM, Caldarone CA, McKenzie ED, Binsalamah ZM. Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation. J Thorac Cardiovasc Surg 2021; 162:1191-1199. [PMID: 33541731 DOI: 10.1016/j.jtcvs.2020.12.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Anomalous aortic origin of a coronary artery (AAOCA) can be associated with myocardial ischemia and sudden cardiac arrest. We compared outcomes data of patients who underwent transection and reimplantation (TAR) and patients who underwent an unroofing. METHODS Patients who presented to the Coronary Artery Anomalies Program were evaluated and managed following a standardized approach. Anatomy was determined using computed tomography angiography, myocardial perfusion using advanced stress imaging, and surgical intervention according to anatomic features. RESULTS Sixty-one patients underwent surgical repair of AAOCA between 2012 and 2019: 16 (26%) patients underwent TAR of the anomalous coronary without an aortic button and 45 (74%) patients underwent coronary unroofing. Compared with patients who underwent an unroofing, patients who underwent TAR had similar intramural length (5 mm with interquartile range of 4-7.7 vs 6 mm with interquartile range of 5-7; P = .6). One patient with an anomalous right coronary underwent coronary artery bypass grafting after TAR because of persistent postoperative ischemic changes. One patient with unroofing of an anomalous left coronary artery presented with recurrent aborted sudden cardiac death and underwent subsequent TAR, without further events. At last follow-up, 15 of 16 patients (94%) who underwent TAR and 42 of 45 (93%) patients who underwent an unroofing were released to unrestricted exercise activities. CONCLUSIONS Coronary artery TAR is a useful surgical alternative for AAOCA when there is a course below the commissure, when unroofing does not relocate the ostium to the appropriate sinus, or when unroofing results in compression by the intercoronary pillar.
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Affiliation(s)
- Carlos Bonilla-Ramirez
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Dana Reaves-O'Neal
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Prakash Masand
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Section of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Tex
| | - Christopher A Caldarone
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - E Dean McKenzie
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Ziyad M Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
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Bonilla-Ramirez C, Molossi S, Caldarone CA, Binsalamah ZM. Anomalous Aortic Origin of the Coronary Arteries - State of the Art Management and Surgical Techniques. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:85-94. [PMID: 34116787 DOI: 10.1053/j.pcsu.2021.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 11/11/2022]
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) can be associated with myocardial ischemia and sudden cardiac arrest. We describe and compare the management and surgical techniques for patients with AAOCA. Patients presenting to the Coronary Artery Anomalies Program are evaluated and managed following a standardized approach. Our approach and data were compared to other single-center and multi-institutional data and results. Patients with AAOCA present as an incidental finding approximately 50% of the time. Advanced axial imaging is essential to define the anatomic characteristics of this lesion. Preoperative and postoperative assessment of myocardial perfusion with provocative testing is feasible and contributes to risk stratification. The surgical techniques for AAOCA repair include coronary unroofing, transection and reimplantation, and neo-ostium creation, among others. In general, surgical repair of AAOCA can mitigate the risk of ischemia with low mortality. The specific morbidities and complications of each different technique should be considered during the surgical planning. Surgical repair of AAOCA can mitigate the risk of ischemia with a low associated mortality but with clinically relevant morbidities. Long-term follow-up is necessary to accurately balance the risks of repaired and unrepaired AAOCA.
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Affiliation(s)
- Carlos Bonilla-Ramirez
- 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
- Coronary Artery Anomalies Program, Texas Children's Hospital; Houston, Texas; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Christopher A Caldarone
- 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
| | - Ziyad M Binsalamah
- 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.
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Sudden cardiac death in children with congenital heart disease: a critical review of the literature. Cardiol Young 2020; 30:1559-1565. [PMID: 33109295 DOI: 10.1017/s1047951120003613] [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: 11/07/2022]
Abstract
Sudden cardiac death is an uncommon but yet catastrophic event, which can occur in neonates and young children. Although extensive research has been carried out assessing the underlying causes, there still remains a degree of uncertainty around this area. Congenital heart disease (CHD) is one known cause of sudden cardiac death in children, the aetiology of which embraces virally induced mechanisms, genetic susceptibility, drug-induced, and maternal factors. Screening tools and investigations including electrocardiograms and echocardiograms alongside a concise history taking and physical examination can be used to identify the potential cardiovascular risk factors of sudden death. This review has comprehensively studied the causes and risk factors for sudden cardiac death in children with CHD and provides a collation and summary of the evidence available so far underpinning the complex link between the two. Moreover, current screening and prevention methods are discussed in detail in order to increase awareness and understanding of how we can improve patient outcomes.
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Han PL, Diao KY, Huang S, Gao Y, Guo YK, Yang ZG, Yang N. Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study. IJC HEART & VASCULATURE 2020; 31:100649. [PMID: 33088901 PMCID: PMC7558218 DOI: 10.1016/j.ijcha.2020.100649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/13/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023]
Abstract
Background Anomalous left coronary artery from the opposite sinus (left-ACAOS) is a rare congenital heart disease. While “interarterial course” is considered as the malignant anatomic feature for these patients, a number of patients with left-ACAOS, who don’t follow the above anatomic pattern, were reported with ischemic symptoms. Purpose This study aims to evaluate the anatomic characteristics of left-ACAOS and their clinical relevance. Methods The coronary computed tomography angiography (CCTA) data from 44 patients with 46 left-ACAOS vessels were retrospectively included. Patients were divided into 2 groups: those with ischemic symptoms (n = 19) and those without ischemic symptoms (n = 25). Baseline clinical characteristics were recorded and the follow-up was done by telephone. CCTA images were reviewed for anomalous coronary artery, take-off angle and level, ostia morphology and grading, proximal narrowing, anomalous course and atherosclerotic plaques. Results The prevalence of left-ACAOS was approximately 0.09% among 48, 719 consecutive patients referred for coronary CTA in our institution. Right sinus of Valsalva (RSV) was the most common origin (36/46, 78.26%). Left-ACAOS arising from right coronary artery (RCA) had narrower proximal segment (P = 0.014) and more prone to atherosclerosis (P = 0.040) than left-ACAOS arising from right sinus of Valsalva (RSV). Proximal narrowing severity (P < 0.001) and degree of maximal coronary stenosis (P = 0.034) of the anomalous left artery was higher in patients with ischemic symptoms than those without. Of note, no MACE was recorded during a mean follow-up of 43.4 ± 26.2 months. Conclusion Left-ACAOS arising from RCA seems to be more prone to atherosclerosis than other subtypes. Proximal narrowing was more severe in patients with ischemia symptoms, which may contribute to risk stratification and clinical management.
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Affiliation(s)
- Pei-Lun Han
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kai-Yue Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Yang
- Cardiothoracic Surgery Department, Guang'an People's Hospital, Sichuan Province, China
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11
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Gerling S, Loose O, Zant R, Michel H, Melter M, Gündisch C, Krutsch V, Krutsch W. Echocardiographic diagnosis of congenital coronary artery abnormalities in a continuous series of adolescent football players. Eur J Prev Cardiol 2019; 26:988-994. [DOI: 10.1177/2047487319825520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sudden cardiac death (SCD) in children and adolescents is rare. Several studies have reported a higher risk of SCD during athletic competition. High risk congenital coronary artery abnormalities are the second leading cause of SCD in young athletes in the USA. Echocardiographic assessment of coronary arteries has not been routinely used in screening programmes for junior athletes so far. Design Prospective cohort study in 1045 consecutive adolescent elite football players. Methods All athletes underwent a standardized cardiovascular screening protocol with a medical history, a physical examination, 12-lead resting electrocardiogram and a complete transthoracic 2D-echocardiography. Results Two athletes (0.19%) showed a high-risk coronary artery abnormality (CAA) with a right coronary artery originating abnormal from the aorta and coursing inter-arterial. Low-risk CAAs were found in 16 athletes (1.53%). There was an ectasia of the left coronary artery (+3.9z and +4.3z) and a fistula from the left coronary artery in two cases (0.19%), respectively. In 1.05% ( n = 11) we found a high take-off (2.3–6.8 mm) and in one case (0.096%) there was a tangential take-off of the right main coronary artery. Variants of coronary arterial anatomy were identified in 335 of 1045 athletes (32.06%). Conclusion Basic pre-participation screening tests including 12-lead or exercise electrocardiogram do not safely identify high-risk CAAs. In adolescent athletes an expert cardiologist is able to describe the origin and the proximal course of the coronary arteries and identify major abnormalities in most of the cases by transthoracic 2D-echocardiography.
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Affiliation(s)
- Stephan Gerling
- Deparment of Paediatrics, University Children's Hospital Regensburg (KUNO), Germany
| | - Oliver Loose
- Department of Paediatric Surgery, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Robert Zant
- Deparment of Paediatrics, University Children's Hospital Regensburg (KUNO), Germany
| | - Holger Michel
- Deparment of Paediatrics, University Children's Hospital Regensburg (KUNO), Germany
| | - Michael Melter
- Deparment of Paediatrics, University Children's Hospital Regensburg (KUNO), Germany
| | | | - Volker Krutsch
- Department of Otorhinolaryngology, Paracelsus Medical University Nuremberg, Germany
| | - Werner Krutsch
- Department of Orthopedics and Traumatology, University Hospital Regensburg, Germany
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12
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Mery CM, De León LE, Molossi S, Sexson-Tejtel SK, Agrawal H, Krishnamurthy R, Masand P, Qureshi AM, McKenzie ED, Fraser CD. Outcomes of surgical intervention for anomalous aortic origin of a coronary artery: A large contemporary prospective cohort study. J Thorac Cardiovasc Surg 2017; 155:305-319.e4. [PMID: 29074047 DOI: 10.1016/j.jtcvs.2017.08.116] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/26/2017] [Accepted: 08/10/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to prospectively analyze the outcomes of patients with anomalous aortic origin of a coronary artery undergoing surgical intervention according to a standardized management algorithm. METHODS All patients aged 2 to 18 years undergoing surgical intervention for anomalous aortic origin of a coronary artery between December 2012 and April 2017 were prospectively included. Patients underwent stress nuclear perfusion imaging, stress cardiac magnetic resonance imaging, and retrospectively electrocardiogram-gated computed tomography angiography preoperatively. Patients were cleared for exercise at 3 months postoperatively if asymptomatic and repeat stress nuclear perfusion imaging, stress cardiac magnetic resonance imaging, and computed tomography angiography showed normal results. RESULTS A total of 44 patients, with a median age of 14 years (8-18 years), underwent surgical intervention: 9 (20%) for the anomalous left coronary artery and 35 (80%) for the anomalous right coronary artery. Surgical procedures included unroofing in 35 patients (80%), translocation in 7 patients (16%), ostioplasty in 1 patient (2%), and side-side-anastomosis in 1 patient (2%). One patient who presented with aborted sudden cardiac death from an anomalous left coronary and underwent unroofing presented 1 year later with a recurrent episode and was found to have an unrecognized myocardial bridge and persistent compression of the coronary requiring reintervention. At last follow-up, 40 patients (91%) are asymptomatic and 4 patients have nonspecific chest pain; 42 patients (95%) have returned to full activity, and 2 patients are awaiting clearance. CONCLUSIONS Surgical treatment for anomalous aortic origin of a coronary artery is safe and should aim to associate the coronary ostium with the correct sinus, away from the intercoronary pillar. After surgery, the majority of patients are cleared for exercise and remain asymptomatic. Longer follow-up is needed to assess the true efficacy of surgery in the prevention of sudden cardiac death.
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Affiliation(s)
- Carlos M Mery
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex.
| | - Luis E De León
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
| | - Silvana Molossi
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
| | - S Kristen Sexson-Tejtel
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
| | - Hitesh Agrawal
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
| | | | - Prakash Masand
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
| | - Athar M Qureshi
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
| | - E Dean McKenzie
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Sibley Heart Center, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Ga
| | - Charles D Fraser
- Coronary Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Tex
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13
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Vijarnsorn C, Noga M, Schantz D, Pepelassis D, Tham EB. Stress perfusion magnetic resonance imaging to detect coronary artery lesions in children. Int J Cardiovasc Imaging 2016; 33:699-709. [PMID: 28000002 DOI: 10.1007/s10554-016-1041-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stress perfusion cardiovascular magnetic resonance (CMR) is used widely in adult ischemic heart disease, but data in children is limited. We sought to evaluate feasibility, accuracy and prognostic value of stress CMR in children with suspected coronary artery disease (CAD). METHODS Stress CMR was reviewed from two pediatric centers over 5 years using a standard pharmacologic protocol. Wall motion abnormalities, perfusion deficits and late enhancement were correlated with coronary angiogram (CAG) when available, and clinical status at 1 year follow-up for major adverse cardiovascular events (MACE; coronary revascularization, non-fatal myocardial infarction and death due to CAD) was recorded. RESULTS Sixty-four stress perfusion CMR studies in 48 children (10.9 ± 4.8 years) using adenosine; 59 (92%) and dipyridamole; 5 (8%), were reviewed. Indications were Kawasaki disease (39%), post arterial switch operation (12.5%), post heart transplantation (12.5%), post anomalous coronary artery repair (11%), chest pain (11%), suspected myocarditis or CAD (3%), post coronary revascularization (3%), and others (8%). Twenty-six studies were performed under sedation. Of all studies performed, 66% showed no evidence of ischemia or infarction, 28% had perfusion deficits and 6% had late gadolinium enhancement (LGE) without perfusion deficit. Compared to CAG, the positive predictive value (PPV) of stress CMR was 80% with negative predictive value (NPV) of 88%. At 1 year clinical follow-up, the PPV and NPV of stress CMR to predict MACE were 78 and 98%. CONCLUSION Stress-perfusion CMR, in combination with LGE and wall motion-analysis is a feasible and an accurate method of diagnosing CAD in children. In difficult cases, it also helps guide clinical intervention by complementing conventional CAG with functional information.
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Affiliation(s)
- Chodchanok Vijarnsorn
- Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. .,Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Michelle Noga
- Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Daryl Schantz
- Variety Children's Hospital, Winnipeg, Manitoba, Canada
| | | | - Edythe B Tham
- Stollery Children's Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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