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Moliterno E, Rovere G, Giarletta L, Brancasi A, Larici AR, Savino G, Bianco M, Meduri A, Palmieri V, Natale L, Marano R. The role of coronary CT angiography in athletes. LA RADIOLOGIA MEDICA 2024; 129:1008-1024. [PMID: 38971947 DOI: 10.1007/s11547-024-01837-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 06/19/2024] [Indexed: 07/08/2024]
Abstract
The sudden death of a young or high-level athlete or adolescent during recreational sports is one of the events with the greatest impact on public opinion in modern society. Sudden cardiac death (SCD) is the principal medical cause of death in athletes and can be the first and last clinical presentation of underlying disease. To prevent such episodes, pre-participation screening has been introduced in many countries to guarantee cardiovascular safety during sports and has become a common target among medical sports/governing organizations. Different cardiac conditions may cause SCD, with incidence depending on definition, evaluation methods, and studied populations, and a prevalence and etiology changing according to the age of athletes, with CAD most frequent in master athletes, while coronary anomalies and non-ischemic causes prevalent in young. To detect silent underlying causes early would be of considerable clinical value. This review summarizes the pre-participation screening in athletes, the specialist agonistic suitability visit performed in Italy, the anatomical characteristics of malignant coronary anomalies, and finally, the role of coronary CT angiography in such arena. In particular, the anatomical conditions suggesting potential disqualification from sport, the post-treatment follow-up to reintegrate young athletes, the diagnostic workflow to rule-out CAD in master athletes, and their clinical management are analyzed.
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Affiliation(s)
- Eleonora Moliterno
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Giarletta
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Brancasi
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Larici
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Massimiliano Bianco
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Agostino Meduri
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Marano
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy.
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
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Maller VV, Johnson JN, Boston U, Knott-Craig C. Transseptal coronary artery-a pictorial review. Pediatr Radiol 2024; 54:1261-1269. [PMID: 38637337 PMCID: PMC11255081 DOI: 10.1007/s00247-024-05911-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] [Received: 11/21/2023] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
A transseptal coronary artery course, also known as a transconal course, is an anomalous course of the left main coronary artery (LMCA) or the left anterior descending artery (LAD) through the conal septal myocardium. The conal septal myocardium is the posterior wall of the right ventricular outflow tract (RVOT), acting as a dividing myocardial wall between the subaortic and subpulmonary outflow tracts. The initial segment of a transseptal coronary artery has an extraconal course between the aorta and the RVOT cranial to the true intramyocardial segment. The transseptal coronary artery then emerges out of the conal septal myocardium at the epicardial surface on the lateral aspect of the RVOT. Many consider the transseptal coronary artery to be a benign entity. However, there are few case reports of severe cardiac symptoms such as myocardial ischemia, arrhythmia, and even sudden cardiac deaths due to potential coronary artery compression in the systolic phase. In this article, we seek to describe the imaging findings of transseptal coronary artery course on coronary computed tomography angiography (CTA), discuss their clinical analysis, and briefly discuss the management of these lesions.
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Affiliation(s)
- Vijetha V Maller
- Department of Radiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, 848 Adams Avenue, Radiology G216, Memphis, TN, USA.
| | - Jason N Johnson
- Division of Pediatric Cardiology, Pediatrics, Heart institute, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Umar Boston
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Heart Institute, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Christopher Knott-Craig
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Heart Institute, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
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3
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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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4
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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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5
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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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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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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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8
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Angelini P, Uribe C. Critical update and discussion of the prevalence, nature, mechanisms of action, and treatment options in potentially serious coronary anomalies. Trends Cardiovasc Med 2023; 33:518-528. [PMID: 35643274 DOI: 10.1016/j.tcm.2022.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
As widely discussed in recent literature, coronary artery anomalies only occasionally lead to potentially serious myocardial ischemic events. The most important group of coronary anomalies has been called anomalous coronary artery origin from an abnormal sinus or a site in the ascending aorta (ACAOS). Only some cases of right- or left-sided intramural-course ACAOS (R-ACAOS-IM or L-ACAOS-IM) can potentially cause significant symptoms or sudden cardiac death, typically during exertion in athletes. After an ACAOS-IM case is qualitatively identified, it is necessary to establish the severity of associated stenosis (which is always present to some degree in ACAOS-IM). The 3 stages of a comprehensive diagnostic process are: 1. initial screening of high-risk populations (young elite athletes, optimally by use of magnetic resonance imaging [MRI]) to identify the prevalence of similar cases in large populations (the denominator of any risk calculation); 2. evaluating symptoms (chest pain, syncope, or sudden death) and performing stress testing; 3. in patients found to carry ACAOS-IM, evaluating the severity of coronary obstruction by intravascular ultrasonography, which is an objective, definitive, and quantifying imaging modality for this condition, essential in selected carriers of such anomalies. The possible treatment alternatives are discussed and updated.
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Affiliation(s)
- Paolo Angelini
- The Center for Coronary Artery Anomalies, Texas Heart Institute, Houston, Texas, United States.
| | - Carlo Uribe
- The Center for Coronary Artery Anomalies, Texas Heart Institute, Houston, Texas, United States
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9
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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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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] [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 Health, University of Milan, Milan, Italy
| | - Blanca Prestini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edoardo Conte
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Davide Marchetti
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Matteo Schillaci
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Eleonora Melotti
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Saima Mushtaq
- Sport Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Fabrizio Tundo
- Sport Cardiology Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio Bartorelli
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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11
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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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12
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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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13
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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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14
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Ponzoni M, Frigo AC, Padalino MA. Surgery for Anomalous Aortic Origin of a Coronary Artery (AAOCA) in Children and Adolescents: A Meta-Analysis. World J Pediatr Congenit Heart Surg 2022; 13:485-494. [PMID: 35757950 DOI: 10.1177/21501351221095424] [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: 11/15/2022]
Abstract
We conducted a systematic review and meta-analysis of the literature to assess the outcomes of surgery for the anomalous aortic origin of a coronary artery in children and young adults (<30 years). Thirteen publications were selected, including a total of 384 patients. Unroofing of the intramural segment was adopted in 92% (95% CI: 81%-98%) of cases, with pooled early and late mortality of 0% (95% CI: 0%-0.3%) and 0.1% (95% CI: 0%-1%), respectively. Reoperation for aortic regurgitation was anecdotal. Surgical management of anomalous aortic origin of coronary arteries can be achieved with excellent results in pediatric patients, but concerns remain about the durability of surgery.
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Affiliation(s)
- Matteo Ponzoni
- Pediatric and Congenital Cardiac Surgery Unit, Padova, Veneto, Italy
| | - Anna C Frigo
- Unit of Biostatistics, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova Medical School, Italy
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15
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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16
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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17
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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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18
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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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19
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Gharibeh L, Rahmouni K, Hong SJ, Crean AM, Grau JB. Surgical Techniques for the Treatment of Anomalous Origin of Right Coronary Artery From the Left Sinus: A Comparative Review. J Am Heart Assoc 2021; 10:e022377. [PMID: 34726074 PMCID: PMC8751967 DOI: 10.1161/jaha.121.022377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The anomalous aortic origin of the right coronary artery (AAORCA) from the left sinus is a congenital anomaly affecting both the origin and course of the right coronary artery. AAORCA is nowadays easily and increasingly recognized by several cardiac imaging modalities. In most cases, patients remain asymptomatic; however, in some, and especially in young athletes, symptoms start to appear following exertion. A literature review was conducted on the surgical management of AAORCA by searching the Pubmed and Google Scholar databases. The inclusion criteria included manuscripts reporting surgical outcomes of AAORCA for ≥1 of the 3 techniques of interest (unroofing, reimplantation, and coronary artery bypass grafting) and manuscripts written in English and that were published between 2010 and 2020. The surgical management of AAORCA can be done through several techniques, most commonly the unroofing of the intramural segment of the AAORCA, the reimplantation of the native right coronary artery onto the right sinus of the aortic root, and coronary artery bypass grafting with either arterial or venous graft conduits with or without ligation of the proximal right coronary artery. Superiority of one surgical technique has not yet been formally proven because of the rare nature of this condition and the lack of any prospective randomized controlled trial or robust prospective observational studies.
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Affiliation(s)
- Lara Gharibeh
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
| | - Kenza Rahmouni
- Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
| | - Seok Joon Hong
- Division of Cardiothoracic Surgery The Valley Hospital Ridgewood NJ
| | - Andrew M Crean
- Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Juan B Grau
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiothoracic Surgery The Valley Hospital Ridgewood NJ
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20
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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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21
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Jegatheeswaran A, Brothers JA. Anomalous aortic origin of a coronary artery: learning from the past to make advances in the future. Curr Opin Pediatr 2021; 33:482-488. [PMID: 34412067 DOI: 10.1097/mop.0000000000001056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review anomalous aortic origin of a coronary artery (AAOCA) anatomy, prevalence, mechanism and risk of ischemia, presentation, evaluation, management, and future directions. RECENT FINDINGS Although most anatomic variants of AAOCA are benign, a small number are associated with increased risk of sudden death. A complete evaluation, including the use of advanced noninvasive imaging and provocative testing should be performed on nearly every patient with AAOCA. On the basis of recent studies, the ischemic risk appears to be greatest with a left anomalous coronary artery but an anomalous right coronary artery is not benign. Other risk factors include: a left anomalous coronary with an intramural course, high take-off, or slit-like orifice, and a right anomalous coronary with a longer intramural course. Exercise restriction is rarely recommended. Management primarily consists of nonoperative care, or surgical repair in those who are symptomatic or who have high-risk variants. Surgery itself continues to evolve; however, it is not benign, with a higher than expected chance of morbidity. SUMMARY Advances have been made over the past decade regarding management of patients with AAOCA; however, the mechanism of ischemia and ability to predict risk is still incompletely understood. Management decisions should be based on anatomy, results of investigations, and shared decision-making with patients and their families. Surgery may be recommended for those at higher risk and should be done at centers experienced in AAOCA surgery. Future research should be collaborative in order to share experiences and insights to help advance our understanding of risk and ultimately to improve patient management.
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Affiliation(s)
- Anusha Jegatheeswaran
- The Hospital for Sick Children, Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julie A Brothers
- The Children's Hospital of Philadelphia and the Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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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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23
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Where's the beef in anomalous coronary artery origin from an opposite aortic sinus? Int J Cardiol 2021; 339:45-46. [PMID: 34216711 DOI: 10.1016/j.ijcard.2021.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
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24
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Virtual endoluminal aortic root views determined at coronary CT angiography - an important tool for improving anomalous coronary artery visualization and surgical planning. Pediatr Radiol 2021; 51:296-306. [PMID: 32889583 DOI: 10.1007/s00247-020-04775-1] [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: 12/23/2019] [Revised: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
Anomalous origin of the coronary arteries, though uncommon, is of great clinical concern. It can be the cause of sudden cardiac death and abnormal cardiac hemodynamics. Advances in electrocardiographically (ECG)-gated multi-detector CT have increased diagnostic accuracy in detecting anomalous origin of coronary arteries and their interarterial and intramural courses. Recent advances in multi-detector CT image processing software have allowed the creation of virtual endoluminal views of the aortic root and improved assessment of the intramural course (the length and relationship to the intercoronary commissure) of the coronary artery, which is of considerable surgical importance. We review our experience with virtual endoluminal imaging in our first 19 cases of interarterial coronary artery anomalies (17 cases of interarterial with intramural segment and 2 cases of purely interarterial course) diagnosed preoperatively and proven surgically.
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25
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Bigler MR, Ashraf A, Seiler C, Praz F, Ueki Y, Windecker S, Kadner A, Räber L, Gräni C. Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence. Front Cardiovasc Med 2021; 7:591326. [PMID: 33553251 PMCID: PMC7859106 DOI: 10.3389/fcvm.2020.591326] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022] Open
Abstract
Coronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). The interarterial variants (with the anomalous vessel situated between the great arteries) are historically called "malignant," based on an anticipated higher risk for myocardial ischemia and sudden cardiac death (SCD), especially affecting young patients during strenuous physical activity. However, the interarterial course itself may not be the predominant cause of ischemia, but rather represents a surrogate for other ischemia-associated anatomical high-risk features. As the exact pathophysiology of ACAOS is not well-understood, there is a lack of evidence-based guidelines addressing optimal diagnostic work-up, downstream testing, sports counseling, and therapeutic options in patients with ACAOS. Therefore, treating physicians are often left with uncertainty regarding the clinical management of affected patients. This review focuses on the pathophysiologic consequences of ACAOS on myocardial ischemia and discusses the concept of the interplay between fixed and dynamic coronary stenosis. Further, we discuss the advantages and limitations of the different diagnostic modalities and give an outlook by highlighting the gaps of knowledge in the assessment of such anomalies.
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Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Afreed Ashraf
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Kadner
- Department of Cardiovascular Surgery, Centre for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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26
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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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Coronary Computed Tomography Angiography in the Clinical Workflow of Athletes With Anomalous Origin of Coronary Arteries From the Contralateral Valsalva Sinus. J Thorac Imaging 2020; 36:122-130. [PMID: 32384413 DOI: 10.1097/rti.0000000000000523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management. MATERIALS AND METHODS Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO). RESULTS CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3±11.0 y) and 22 AORCA (18 males; 29.1±16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P<0.05) and proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO). All AOLCA/AORCA athletes were disqualified from competitive sports and warned to avoid vigorous physical efforts. Surgery was recommended to all AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent surgery. No major cardiovascular event/ischemic symptoms/signs developed during a mean follow-up of 49.6±39.5 months. CONCLUSION CCTA provides essential information for safe/effective clinical management of athletes, with important prognostic/sport-activity implications.
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Das M, Narayan P. Coronary artery bypass grafting in children for atheromatous and non-atheromatous lesions. Indian J Thorac Cardiovasc Surg 2020; 37:155-164. [PMID: 33584031 DOI: 10.1007/s12055-020-00946-9] [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: 11/19/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
Coronary artery involvement in children is an uncommon but well-recognized clinical entity. It is an important cause for sudden cardiac death in children. Diagnosis requires a high index of suspicion since it has serious consequences when missed. Presentation of coronary artery abnormality is very variable due to congenital as well as acquired aetiology. In this review, we have described the different causes that require coronary artery bypass grafting in children and their pathogenesis. The nuances of conduit selection, graft behaviour in children, patency rates and long-term outcomes in children undergoing coronary artery bypass have also been discussed.
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Affiliation(s)
- Mrinalendu Das
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
| | - Pradeep Narayan
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, 124, EM Bypass, Mukundapur, Kolkata, 700099 India
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Frommelt P, Lopez L, Dimas VV, Eidem B, Han BK, Ko HH, Lorber R, Nii M, Printz B, Srivastava S, Valente AM, Cohen MS. Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography: Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:259-294. [PMID: 32143778 DOI: 10.1016/j.echo.2019.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Frommelt
- Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Leo Lopez
- Stanford University, Palo Alto, California
| | | | | | - B Kelly Han
- Children's Minnesota and the Minneapolis Heart Institute, Minneapolis, Minnesota
| | - H Helen Ko
- Kravis Children's Hospital, Mount Sinai Medical Center, New York, New York
| | - Richard Lorber
- Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Masaki Nii
- Shizuoka Children's Hospital, Shizuoka, Shizuoka, Japan
| | - Beth Printz
- University of California San Diego and Rady Children's Hospital, San Diego, California
| | | | - Anne Marie Valente
- Boston Children's Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meryl S Cohen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Doan TT, Zea-Vera R, Agrawal H, Mery CM, Masand P, Reaves-O’Neal DL, Noel CV, Qureshi AM, Sexson-Tejtel SK, Fraser CD, Molossi S. Myocardial Ischemia in Children With Anomalous Aortic Origin of a Coronary Artery With Intraseptal Course. Circ Cardiovasc Interv 2020; 13:e008375. [DOI: 10.1161/circinterventions.119.008375] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Intraseptal anomalous aortic origin of a coronary artery is considered a benign condition. However, there have been case reports of patients with myocardial ischemia, arrhythmia, and sudden cardiac death. The purpose of this study was to determine the clinical presentation, myocardial perfusion on provocative stress testing, and management of children with anomalous aortic origin of a coronary artery with an intraseptal course in a prospective cohort.
Methods:
Patients with anomalous aortic origin of a coronary artery and intraseptal course were prospectively enrolled from December 2012 to May 2019, evaluated, and managed following a standardized algorithm. Myocardial perfusion was assessed using stress imaging. Fractional flow reserve was performed in patients with myocardial hypoperfusion on noninvasive testing. Exercise restriction, β-blockers, and surgical intervention were discussed with the families.
Results:
Eighteen patients (female 6, 33.3%), who presented with no symptoms (10, 55.6%), nonexertional (4, 22.2%), and exertional symptoms (4, 22.2%), were enrolled at a median age of 12.4 years (0.3–15.9). Perfusion imaging was performed in 14/18 (77.8%) and was abnormal in 7/14 (50%); fractional flow reserve was positive in 5/8 (62.5%). All 4 patients with exertional symptoms and 3/10 (30%) with no or nonexertional symptoms had myocardial hypoperfusion. Coronary artery bypass grafting was performed in a 4-year-old patient; β-blocker and exercise restriction were recommended in 4 patients not suitable for surgery. One patient had nonexertional chest pain and 17 were symptom-free at median follow-up of 2.5 years (0.2–7.1).
Conclusions:
Up to 50% of patients with intraseptal anomalous aortic origin of a coronary artery had inducible myocardial hypoperfusion during noninvasive provocative testing. Long-term follow-up is necessary to understand the natural history of this rare anomaly.
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Affiliation(s)
- Tam T. Doan
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Rodrigo Zea-Vera
- Texas Children’s Hospital and General Surgery Residency Program (R.Z.V.), Baylor College of Medicine, Houston
| | - Hitesh Agrawal
- Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis (H.A.)
| | - 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 (C.M.M., C.D.F.)
| | - Prakash Masand
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
- Section of Pediatric Radiology (P.M.), Baylor College of Medicine, Houston
| | - Dana L. Reaves-O’Neal
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Cory V. Noel
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Athar M. Qureshi
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - S. Kristen Sexson-Tejtel
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Charles D. Fraser
- 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 (C.M.M., C.D.F.)
| | - Silvana Molossi
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
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Ishigaki M, Kim SH, Nii M, Sato K, Yoshimoto J, Mitsushita N, Tanaka Y. Successful transcatheter closure of coronary artery fistula in a patient with anomalous aortic origin of the left main coronary artery from the right aortic sinus. J Cardiol Cases 2019; 21:141-144. [PMID: 32256862 DOI: 10.1016/j.jccase.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 10/25/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022] Open
Abstract
Transcatheter closure is an established method to treat coronary artery fistula (CAF). We present transcatheter closure in a 6-year-old girl with CAF and anomalous aortic origin of the left main coronary artery from the right aortic sinus. The CAF originated from the left coronary artery (LCA), coursed through the interventricular septum (intraseptal course) with prominent dilation, and drained into the right ventricular outflow tract. She underwent transcatheter closure and was in a stable condition at the 3-year follow-up with regression of the dilated portion of the intraseptal-type LCA. Hence, transcatheter closure of CAF is feasible in patients with anomalous origins of coronary arteries. <Learning objective: This report describes the feasibility and safeness of transcatheter closure of a coronary artery fistula in a patient with an anomalous origin of a coronary artery. This is the first report to visualize the regression of the markedly dilated left coronary artery with an intraseptal course.>.
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Affiliation(s)
- Mizuhiko Ishigaki
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Sung-Hae Kim
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keisuke Sato
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Jun Yoshimoto
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Norie Mitsushita
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yasuhiko Tanaka
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
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Harky A, Noshirwani A, Karadakhy O, Ang J. Comprehensive literature review of anomalies of the coronary arteries. J Card Surg 2019; 34:1328-1343. [DOI: 10.1111/jocs.14228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Arish Noshirwani
- Department of Cardiothoracic SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | | | - Juliana Ang
- School of MedicineUniversity of LiverpoolLiverpool UK
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Wu Q, Li ZZ, Yue F, Wei F, Zhang CY. Percutaneous coronary intervention for ostial lesions of the left main stem in a patient with congenital single left coronary artery: A case report. World J Clin Cases 2019; 7:2128-2133. [PMID: 31423447 PMCID: PMC6695546 DOI: 10.12998/wjcc.v7.i15.2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Single coronary artery (SCA) originating from a solitary ostium in the aorta and perfusing the entire myocardium is a very rare congenital anomaly of the coronary artery. Furthermore, a right coronary artery (RCA) arising from the mid segment of the left anterior descending artery (LAD) is an extremely uncommon variation of SCA.
CASE SUMMARY A 76-year-old woman presented a 5-mo history of exertional angina. Selective coronary angiography revealed an SCA, with severe ostial stenosis that originated from the left sinus of Valsalva and bifurcated normally into the LAD and circumflex coronary artery. In addition, an anomalous RCA originated from the mid segment of the LAD as a separate branch. Successful balloon angioplasty and stenting for the SCA ostial stenosis were performed on the patient.
CONCLUSION Percutaneous coronary intervention (PCI) of the main trunk for SCA is very similar to PCI of an unprotected left main coronary artery. Although technical difficulties and risks do exist, PCI for severe ostial stenosis of the main trunk is safe and efficacious in selected SCA patients.
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Affiliation(s)
- Qiang Wu
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, 550002, Guizhou Province, China
| | - Zong-Zhuang Li
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, 550002, Guizhou Province, China
| | - Feng Yue
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, 550002, Guizhou Province, China
| | - Fang Wei
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, 550002, Guizhou Province, China
| | - Chen-Yun Zhang
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, 550002, Guizhou Province, China
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Mainwaring RD, Hanley FL. Surgical treatment of anomalous left main coronary artery with an intraconal course. CONGENIT HEART DIS 2019; 14:504-510. [PMID: 31343841 DOI: 10.1111/chd.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Anomalous left main coronary artery (LMCA) with an intraconal course is a relatively rare form of anomalous aortic origin of a coronary artery (AAOCA) from the wrong sinus of Valsalva. There is currently a paucity of information regarding this entity. The purpose of this article is to review our surgical experience with repair of anomalous LMCA with an intraconal course. METHODS This was a retrospective review of 12 patients with an anomalous LMCA and an intraconal course who underwent surgical repair. The median age at surgery was 15 years (range 2-47). The seven oldest patients all had preoperative symptoms of exertional chest pain and one also had exertional syncope. The five youngest patients had no preoperative symptoms. One of these patients had a hemodynamically significant ventricular septal defect and one patient was the sibling of a patient who had undergone repair of AAOCA. RESULTS The 12 patients underwent surgical repair including unroofing of the myocardial bridge overlying the intraconal LMCA and a LeCompte procedure. There was no early or late mortality and there were no significant complications. All 12 patients have resumed normal, unrestricted activities. CONCLUSIONS Twelve patients with an anomalous LMCA and intraconal course presented to our institution for treatment. Surgical repair was performed successfully in all 12, with resolution of symptoms in the 7 patients who were symptomatic preoperatively. These results suggest that the surgical treatment is safe and efficacious in patients with an anomalous LMCA and intraconal course.
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Affiliation(s)
- Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California
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Agati S, Secinaro A, Caldaroni F, Calvaruso D, Manuri L, Gitto P, Ferro G, Anderson R, Vouhè PR, Zanai R, Campanella I. Perfusion Study Helps in the Management of the Intraseptal Course of an Anomalous Coronary Artery. World J Pediatr Congenit Heart Surg 2019; 10:360-363. [PMID: 31084306 DOI: 10.1177/2150135119829004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.
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Affiliation(s)
- Salvatore Agati
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Aurelio Secinaro
- 2 Imaging Department-"Bambino Gesù" Pediatric Hospital, Rome, Italy
| | | | - Davide Calvaruso
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Lucia Manuri
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Placido Gitto
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Giuseppe Ferro
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Robert Anderson
- 3 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Pascal R Vouhè
- 3 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rosanna Zanai
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Ivana Campanella
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
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Krueger M, Cronin P, Sayyouh M, Kelly AM. Significant incidental cardiac disease on thoracic CT: what the general radiologist needs to know. Insights Imaging 2019; 10:10. [PMID: 30725202 PMCID: PMC6365314 DOI: 10.1186/s13244-019-0693-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Incidental cardiac findings are often found on chest CT studies, some of which may be clinically significant. The objective of this pictorial review is to illustrate and describe the appearances and management of the most frequently encountered significant cardiac findings on non-electrocardiographically gated thoracic CT. Most radiologists will interpret multidetector chest CT and should be aware of the imaging appearances, significance, and the appropriate next management steps, when incidental significant cardiac disease is encountered on thoracic CT. Conclusion This article reviews significant incidental cardiac findings which may be encountered on chest CT studies. After completing this review, the reader should not only be familiar with recognizing clinically significant cardiac findings seen on thoracic CT examinations but also have the confidence to direct their further management.
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Affiliation(s)
- Maren Krueger
- Fulford Radiology, Base Hospital, Private Bag 2016, New Plymouth, Taranaki, 4342, New Zealand
| | - Paul Cronin
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mohamed Sayyouh
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aine Marie Kelly
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Angelini P, Uribe C. Anatomic spectrum of left coronary artery anomalies and associated mechanisms of coronary insufficiency. Catheter Cardiovasc Interv 2018; 92:313-321. [PMID: 30051621 DOI: 10.1002/ccd.27656] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/21/2018] [Accepted: 04/15/2018] [Indexed: 11/11/2022]
Abstract
This is a novel re-appraisal of an understudied and misunderstood group of important coronary anomalies. The general name of the group is "anomalous origin of the left coronary artery," but several additional details should be included in this group of anomalies and the explanation of their pathophysiology. The most lethal form in young athletes or military recruits features intramural aortic proximal course. This comprehensive review is based on a large experience at a dedicated center for coronary artery anomalies, using evolving knowledge (over 20 years) while employing prospective and disciplined programs of evaluation and treatment, according to the nature and severity of each anomaly. The most common pathogenic mechanism of coronary dysfunction relates to intramural coronary course, with or without ectopic origin, leading to variable lateral compression and stenosis inside the aortic tunica media; this compression is present at rest and worsens with exertion. We propose that such variable and dynamic stenoses can be best studied by examining their specific anatomy and clinical presentation, stress testing, and, most importantly, in vivo evaluation by intravascular ultrasonography. Such methods should be used to support individual risk evaluation and selection among treatment options.
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Affiliation(s)
- Paolo Angelini
- Department of Cardiology, Texas Heart Institute, Houston, Texas
| | - Carlo Uribe
- Department of Cardiology, Texas Heart Institute, Houston, Texas
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Glushko T, Seifert R, Brown F, Vigilance D, Iriarte B, Teytelboym OM. Transseptal course of anomalous left main coronary artery originating from single right coronary orifice presenting as unstable angina. Radiol Case Rep 2018; 13:549-554. [PMID: 29849856 PMCID: PMC5966622 DOI: 10.1016/j.radcr.2018.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/04/2018] [Indexed: 12/02/2022] Open
Abstract
Transseptal course of coronary artery has often been described as a benign entity; however, this report and literature analysis provides growing evidence of high risk of serious cardiovascular events in this anomaly. We present a case of unstable angina in a patient with anomalous common origin of left and right coronary arteries from a single coronary ostium at the right sinus of Valsalva, with subsequent transseptal course of the left main artery, review of relevant literature, and discussion of possible management options.
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Affiliation(s)
- Tetiana Glushko
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Richard Seifert
- Department of Cardiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Fraser Brown
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Deon Vigilance
- Department of Cardiothoracic Surgery, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Blanca Iriarte
- Department of Internal Medicine, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - Oleg M Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
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Anomalous origin of coronary arteries from the "wrong" sinus in athletes: Diagnosis and management strategies. Int J Cardiol 2017; 252:13-20. [PMID: 29146296 DOI: 10.1016/j.ijcard.2017.10.117] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/28/2017] [Accepted: 10/31/2017] [Indexed: 12/22/2022]
Abstract
AIMS Although anomalous origin of left (AOLCA) and right coronary artery (AORCA) from the wrong sinus may cause sudden death (SD) in athletes, early diagnosis and management of these anomalies are still challenging. We analysed clinical/instrumental profiles of athletes identified with AOLCA/AORCA focusing our attention on diagnosis, management and follow-up. METHODS AND RESULTS We report 23 athletes (17 males, mean age 27±17yrs.), 6 with AOLCA and 17 with AORCA. Diagnosis was made by trans-thoracic echocardiography (TTE) in 21/23(91%). Symptoms were present only in 10(41%). Only 3 had an abnormal rest-ECG and 9(39%) an abnormal stress test ECG (3 ST-depression, 4 ventricular arrhythmias, 1 supraventricular arrhythmias, 1 rate-dependent left-bundle-branch-block). Anatomy of the anomalous coronary artery showed no significant correlation with clinical presentation, except for a tendency to higher occurrence of proximal hypoplasia in symptomatic athletes (83% vs 40%, p=0.09). All athletes were disqualified from competitive-sports and advised to avoid strenuous effort. Surgery was recommended to all athletes with AOLCA and 6 with AORCA, but only 6 underwent surgery. No major cardiac events or ischemic symptoms/signs occurred during a mean follow-up of 65±70months. CONCLUSIONS Early diagnosis of AOLCA/AORCA in athletes is feasible by TTE. Typical symptoms/signs of myocardial ischemia are present only in one third of cases thus underlying the need of a high index of clinical suspicion to achieve the diagnosis. After exercise restriction, none had major cardiac events or ischemia symptoms/signs recurrence. There was no correlation between anatomical characteristics and clinical presentation with the possible exception of coronary hypoplasia.
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Cheezum MK, Liberthson RR, Shah NR, Villines TC, O'Gara PT, Landzberg MJ, Blankstein R. Anomalous Aortic Origin of a Coronary Artery From the Inappropriate Sinus of Valsalva. J Am Coll Cardiol 2017; 69:1592-1608. [PMID: 28335843 DOI: 10.1016/j.jacc.2017.01.031] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/05/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) from the inappropriate sinus of Valsalva is increasingly recognized by cardiac imaging. Although most AAOCA subtypes are benign, autopsy studies report an associated risk of sudden death with interarterial anomalous left coronary artery (ALCA) and anomalous right coronary artery (ARCA). Despite efforts to identify high-risk ALCA and ARCA patients who may benefit from surgical repair, debate remains regarding their classification, prevalence, risk stratification, and management. We comprehensively reviewed 77 studies reporting the prevalence of AAOCA among >1 million patients, and 20 studies examining outcomes of interarterial ALCA/ARCA patients. Observational data suggests that interarterial ALCA is rare (weighted prevalence = 0.03%; 95% confidence interval [CI]: 0.01% to 0.04%) compared with interarterial ARCA (weighted prevalence = 0.23%; 95% CI: 0.17% to 0.31%). Recognizing the challenges in managing these patients, we review cardiac tests used to examine AAOCA and knowledge gaps in management.
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Affiliation(s)
- Michael K Cheezum
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Cardiology Service, Fort Belvoir Community Hospital, Ft. Belvoir, Virginia.
| | - Richard R Liberthson
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nishant R Shah
- Lifespan Cardiovascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Brown University Alpert School of Medicine, Providence, Rhode Island
| | - Todd C Villines
- Department of Medicine, Cardiology Service, Walter Reed National Military Medical Center, Bethesda Maryland
| | - Patrick T O'Gara
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Ron Blankstein
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Brothers JA, Frommelt MA, Jaquiss RD, Myerburg RJ, Fraser CD, Tweddell JS. Expert consensus guidelines: Anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg 2017; 153:1440-1457. [DOI: 10.1016/j.jtcvs.2016.06.066] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023]
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Gräni C, Buechel RR, Kaufmann PA, Kwong RY. Multimodality Imaging in Individuals With Anomalous Coronary Arteries. JACC Cardiovasc Imaging 2017; 10:471-481. [DOI: 10.1016/j.jcmg.2017.02.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/08/2017] [Accepted: 02/15/2017] [Indexed: 01/02/2023]
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Abstract
In the present review, we summarize current approaches to the prevention of sudden cardiac death (SCD) in children and young adults, focusing on age less than 35 years. SCD in the young is rare, but devastating from the societal perspective. While coronary artery disease is the main etiology of SCD in the older age groups, conditions such as cardiomyopathies and electrical channelopathies are more likely to be found in the young. In the majority of younger cases, cardiac arrest can be the first recognized manifestation of the underlying cardiac pathology, although some have experienced cardiovascular symptoms prior to the SCD. Since identification of a cardiac disease is pivotal for implementation of appropriate preventive measures, measures such as electrocardiographic screening in subpopulations such as athletes have been proposed. However, these efforts are impeded by the large number of individuals needed to test in order to find one with cardiac disease, leading to significant rates of false positive findings and high costs. When a high-risk cardiac condition is identified in a young person, measures of lifestyle modification, appropriate medical treatment and ICD implantation in selected individuals based on risk stratification are warranted. Nevertheless, the benefits of lifelong ICD therapy need to be balanced with long-term complications and quality of life.
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Affiliation(s)
- Aapo L Aro
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.,Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Sumeet S Chugh
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Mosca RS, Phoon CKL. Anomalous Aortic Origin of a Coronary Artery Is Not Always a Surgical Disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 19:30-6. [PMID: 27060040 DOI: 10.1053/j.pcsu.2015.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/11/2022]
Abstract
Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has become a high-profile lesion as a result of its association with sudden cardiac death in otherwise young and healthy individuals. Despite our incomplete knowledge of its pathophysiology and natural history, surgical intervention is often recommended. Evidence now shows AAOCA to be relatively common, with lower than previously suspected rates of sudden cardiac death. Analysis of this information reveals that AAOCA is not always a surgical disease. Future multi-institutional studies will continue to define those subgroups best served by observation or surgery.
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Affiliation(s)
- Ralph S Mosca
- George E. Reed Professor of Cardiac Surgery Vice Chairman, Clinical Affairs, Chief, Division of Congenital Cardiac Surgery, NYU Langone Medical Center, New York, NY
| | - Colin K L Phoon
- Division of Pediatric Cardiology, NYU Langone Medical Center, New York, NY.
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Herrmann JL, Goldberg LA, Khan AM, Partington SL, Brothers JA, Mascio CE, Spray TL, Kim YY, Fuller S. A Comparison of Perioperative Management of Anomalous Aortic Origin of a Coronary Artery Between an Adult and Pediatric Cardiac Center. World J Pediatr Congenit Heart Surg 2016; 7:721-726. [DOI: 10.1177/2150135116668333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/25/2016] [Indexed: 11/17/2022]
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA) presents in varying age-groups. Assuming management algorithms differ between pediatric and adult institutions, we compared the perioperative management of patients with AAOCA at two such centers. Methods: A retrospective review was conducted at a pediatric and an adult institution of patients 14 years or older who underwent surgical repair of AAOCA between January 2000 and May 2014. Results: Twenty patients from the pediatric center (median age: 16.5 years, range: 14-18 years) and nine patients from the adult center (median age: 40 years, range: 37-52 years) were included. An anomalous aortic origin of a right coronary artery was the most frequent pathology at each institution. Chest pain was the most common presenting symptom at both institutions. Preoperative echocardiography was performed in 95% patients at the pediatric center and in 100% of patients at the adult center. Cardiac catheterization was utilized more frequently at the adult center, and cardiac magnetic resonance imaging more commonly employed at the pediatric center. Isolated coronary unroofing was performed in 19 of 20 cases at the pediatric center and in only 2 (22%) cases at the adult institution, both by congenitally trained cardiac surgeons. More concomitant cardiac procedures were performed at the adult center with associated longer operative times and hospital stays. Conclusion: Management strategies for AAOCA vary depending on both patient-specific factors and expertise of the managing team. Further studies are needed to optimally standardize diagnostic and treatment pathways regardless of location venue.
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Affiliation(s)
- Jeremy L. Herrmann
- Division of Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leah A. Goldberg
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail M. Khan
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L. Partington
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julie A. Brothers
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher E. Mascio
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L. Spray
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yuli Y. Kim
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Abstract
PURPOSE OF REVIEW To better understand the risk of sudden death from coronary anomalies. RECENT FINDINGS Most coronary anomalies are benign, but there are certain coronary anomalies that increase the risk of sudden cardiac death (SCD) in the young, notably anomalous aortic origin of a coronary artery from the wrong sinus. Previously, the risk of SCD attributed to certain coronary anomalies was felt to be quite high, as the risk assessment was based on autopsy series. Recent studies have shown that the risk attributed to anomalous coronary arteries is much lower than once believed. Risk appears to be highest with anomalous left coronary artery from the right sinus of Valsalva with interarterial course, notably when the young patient is participating in vigorous physical exertion, such as with competitive sports. SUMMARY Treatment strategies may include exercise restriction or surgical repair. Management decisions should be based on a complete understanding of the risk for SCD because of anomalous coronary arteries. Future directions should focus on better methods to risk stratify these pediatric patients.
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Abstract
OBJECTIVES The objectives of this review are to discuss the spectrum of coronary artery anomalies and the evidence behind current treatment strategies. DATA SOURCE MEDLINE and PubMed. CONCLUSION Coronary artery anomalies exist in up to 1% of the population and most of these do not cause symptoms or ischemia and do not require any surgical intervention whereas others are potentially fatal. The type of surgical intervention is often dictated by the type of lesion, and upon the unique anatomic and physiologic variables associated with each lesion. Postoperative care can be challenging particularly after surgical repair of anomalous left coronary artery from the pulmonary artery.
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