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Michałowska AM, Skowroński J, Michałowska I, Tyczyński P, Kowalik I, Wolny R, Opolski MP, Demkow M, Hoffman P, Lazarczyk H, Kruk M, Kepka C, Kusmierczyk M, Witkowski A, Pręgowski J. Computed tomographic characteristics of congenital coronary artery fistulas in an adult population. Kardiol Pol 2023; 81:1217-1226. [PMID: 37997822 DOI: 10.33963/v.kp.97829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Coronary artery fistulas (CAFs) are usually congenital coronary artery anomalies of termination. AIMS This study aimed to assess the prevalence, anatomic characteristics, and clinical significance of CAFs detected by computed tomography (CT) in an adult population. METHODS We performed 45 817 CT examinations in 39 066 subjects between 2008 and 2020. The electronic database was manually checked using specific keywords to identify patients with CAFs. The CT characteristics of CAFs were evaluated. CAF was defined as clinically significant if it was the most plausible cause of myocardial infarction, infective endocarditis, heart failure, death during follow-up, hospitalization, or if it required either percutaneous or surgical intervention. RESULTS Of 39 066 patients, 56 CAFs were detected in 42 subjects (20 men, 47.6%) with a prevalence of 0.11%. Most CAFs originated from the right coronary artery (RCA) (48.2%) and drained into the pulmonary artery (PA) (58.9%). CAFs terminating in the PA were more frequently multiple (P <0.001) and tortuous (P <0.001) as compared to CAFs without PA drainage. Clinically significant CAFs, identified in 7 of 42 patients, were more common in younger (P = 0.03) and male (P = 0.04) subjects and had larger lumen area and diameter at the site of origin (P = 0.03, P = 0.03, respectively). CONCLUSIONS In the unselected adult population undergoing coronary CT angiography, the RCA and the PA are the most common sites of origin and termination of CAFs, respectively. CAFs draining into the PA are more often multiple and tortuous. Clinically meaningful CAFs are larger and most frequently detected in younger and male patients.
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Affiliation(s)
- Anna Maria Michałowska
- National Institute of Cardiology, Warszawa, Poland.
- Department of Diagnostic Radiology, The National Institute of Medicine of the Ministry of Interior and Administration, Warszawa, Poland.
| | - Jarosław Skowroński
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Ilona Michałowska
- Department of Radiology, National Institute of Cardiology, Warszawa, Poland
| | - Paweł Tyczyński
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Ilona Kowalik
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warszawa, Poland
| | - Rafał Wolny
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | | | - Marcin Demkow
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Piotr Hoffman
- Congenital Heart Diseases Department, National Institute of Cardiology, Warszawa, Poland
| | | | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Cezary Kepka
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Jerzy Pręgowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
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Chahal NK, Horak JG, Thalji NK, Augoustides JG, Garner CR, Bradshaw JD, Fernando RJ, Krishnan S, Desai RG, Patel KM. Left Coronary Artery Reimplantation for Repair of Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery in an Adult. J Cardiothorac Vasc Anesth 2023; 37:2098-2108. [PMID: 37516597 DOI: 10.1053/j.jvca.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Navdeep K Chahal
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jiri G Horak
- Cardiothoracic and Critical Care Anesthesiology Sections, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Nabil K Thalji
- Cardiothoracic Anesthesiology Section, Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Chandrika R Garner
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Winston Salem, NC
| | - John D Bradshaw
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Winston Salem, NC.
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine, Pontiac, MI
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
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Sarıoğlu T, Doğan A, Yalçınbaş Y, Erek E, Arnaz A, Türköz R, Oktay A, Saygılı A, Altun D, Yüksek A, Boz M, Sarıoğlu A. Surgical procedures for coronary arteries in pediatric cardiac surgery: Risk factors and outcomes. J Card Surg 2021; 36:2289-2299. [PMID: 33797801 DOI: 10.1111/jocs.15547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data exist regarding the coronary revascularization procedures needed during the repair of several congenital and pediatric cardiac malformations. We aimed to determine risk factors for in-hospital mortality and long-term outcomes of various pediatric coronary revascularization procedures. METHODS We retrospectively reviewed the records of 32 consecutive pediatric patients who underwent coronary revascularization procedures at our institution between May 1995 and June 2020. In-hospital mortality, risk factors, surgical indications, revascularization patency, and mid- and long-term follow-up data were investigated. Patients were categorized into the coronary artery bypass grafting (n = 11) and other coronary artery procedure (n = 21) groups. RESULTS The median age and weight of patients at the time of surgery were 9 months and 4.8 kg, respectively. There were five in-hospital deaths (5/32, 15.6%). The mortality rates were 27.2% (3/11) in the coronary artery bypass grafting group and 9.5% (2/21) in the other coronary artery procedure group (p = .206; 95% confidence interval: 0.496-25.563). The mortality rates for planned and rescue procedures were 8.3% (2/24) and 37.5% (3/8) (p = .06), respectively. The median follow-up time was 12.5 years. Control imaging studies for coronary patency were performed in 70.3% (19/27) of surviving patients. The overall coronary patency rate was 94.7% (18/19). CONCLUSIONS Pediatric coronary revascularization procedures with elective-planned indications can be performed with good outcomes. Young age and rescue and emergency procedures may carry an increased risk of in-hospital mortality, although not found to be statistically significant. Surviving patients require lifelong follow-up regarding the patency of reperfused coronary arteries.
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Affiliation(s)
- Tayyar Sarıoğlu
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Yusuf Yalçınbaş
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ersin Erek
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Ahmet Arnaz
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Rıza Türköz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayla Oktay
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Arda Saygılı
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Dilek Altun
- Department of Anesthesiology and Reanimation, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Adnan Yüksek
- Department of Anesthesiology and Reanimation, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Murat Boz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayşe Sarıoğlu
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
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Pun B, Shrestha A, Karki B, Tuladhar AS. Congenital absence of left circumflex artery with right coronary dominance. Clin Case Rep 2021; 9:570-571. [PMID: 33489217 PMCID: PMC7813112 DOI: 10.1002/ccr3.3457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/12/2020] [Indexed: 12/02/2022] Open
Abstract
Absent left circumflex coronary (LCX) artery though rare and benign should be considered in patients with chest pain and differentiated from atherosclerotic coronary artery disease for better management & prognosis.
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Affiliation(s)
- Bishika Pun
- Department of RadiologyOm Hospital and Research CenterKathmanduNepal
| | - Amit Shrestha
- Department of RadiologyOm Hospital and Research CenterKathmanduNepal
| | - Bipin Karki
- Department of Critical Care MedicineOm Hospital and Research CenterKathmanduNepal
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Al-Sadawi M, Madoukh B, Battisha A, Shaikh S, Theetha Kariyanna P, Marmur J, Abdellateef TS, Hevroni G, McFarlane SI. Malignant Course of the Right Coronary Artery Originating from the Left Main Coronary Artery: An Odd Exit. Am J Med Case Rep 2019; 7:311-6. [PMID: 31633013 DOI: 10.12691/ajmcr-7-12-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Congenital coronary artery anomalies are quite uncommon with estimates ranging from 0.2% to 1.3% on coronary angiography. The rarity of these anomalies makes their diagnosis a formidable challenge. Variable arterial courses have been described. In this report, we present a case with unique arterial course, which starts as a hyperacute take-off of the right coronary artery (RCA) from the left main coronary artery (LMCA), with subsequent coursing, without external compression, between the right ventricular outflow tract and aorta. Our case is relevant to the concept of whether we should keep a reasonable index of suspicion for coronary artery anomalies during cardiac evaluations of patients undergoing non-cardiac surgeries. CLINICAL CASE This is an asymptomatic 47-year-old African American female who presented for cardiac clearance for renal transplantation. She had a past medical history of hypertension, bronchial asthma, and former smoking of 10 years (quitting 15 years prior to presentation). She also has end-stage renal disease on hemodialysis. Cardiac workup revealed left ventricular hypertrophy on EKG, multi-chamber dilation seen on echo, and anomalous RCA course seen on CT coronary angiography. Cardiac catheterization revealed non-obstructive coronary artery disease of the LCX and RCA. After consulting with cardiothoracic surgery, conservative medical management was decided based on the patient's risk stratification. She was advised to have close monitoring of her condition. DISCUSSION Coronary artery anomalies represent the second most common cause of sudden cardiac death in young athletes. At this time, the prevalence of right coronary artery (RCA) take off from the left coronary sinus occurs at a percentage of 0.019% to 0.49%. The RCA origination from the left main coronary artery (LMCA) accounts for only 0.65% of these anomalies. Our patient had high-risk anatomy consisting of a hyper-angulated take-off of the RCA from the LMCA as well as course between the pulmonary artery and right ventricular outflow tract (RVOT). CT coronary angiography is the most useful imaging modality that characterizes coronary artery anomalies. Although this patient exhibited no signs or symptoms of cardiorespiratory compromise, she warranted a full cardiac workup preoperatively that incidentally revealed a coronary anomaly. Recognition of this disease is critical for timely prevention of potential complications as well as discussion of goals of care. Guidelines for medical versus surgical management are available, but the management strategy should be individualized, with the highest consideration given to risk-benefit analysis.
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Al-Sadawi M, Taitt HA, Haddadin M, Shaikh S, Almasri M, Hartt A, McFarlane SI. "Coronary Confusion" Congenital Anomaly of the Left Main Coronary Artery Presenting as a Myocardial Infarction in a Young Female. Am J Med Case Rep 2019; 7:41-5. [PMID: 31396549 DOI: 10.12691/ajmcr-7-3-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Coronary artery anomalies are rare congenital disorders occurring in 0.3-5.6 % of the population. However, it carries a potential risk of sudden death in young athletes due to the development of premature coronary artery disease. The diagnosis of coronary artery anomalies is usually made incidentally; commonly found while investigating other cardiac conditions. A coronary CT angiography and traditional interventional angiography are the gold standards for diagnosing congenital coronary artery anomalies. Here, we present a case of a 27 year-old female with a history of hypertension and membranous glomerulonephritis with proteinuria presenting with an inferior ST elevation myocardial infarction. Cardiac catheterization revealed an anomalous origin of the left anterior descending artery from the right coronary cusp and absence of the left circumflex artery with a super-dominant right coronary artery. The patient had an occlusion of the right posterior descending artery and the right posterolateral segment. We discuss the clinical diagnosis and intervention of the case along with review of the literature.
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Dalal A, Czosek RJ, Kovach J, von Alvensleben JC, Valdes S, Etheridge SP, Ackerman MJ, Auld D, Huckaby J, McCracken C, Campbell R. Clinical Presentation of Pediatric Patients at Risk for Sudden Cardiac Arrest. J Pediatr 2016; 177:191-196. [PMID: 27502104 DOI: 10.1016/j.jpeds.2016.06.088] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/16/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify the clinical presentation of children and adolescents affected by 1 of 4 cardiac conditions predisposing to sudden cardiac arrest: hypertrophic cardiomyopathy, long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and anomalous origin of the left coronary artery from the right sinus of Valsalva (ALCA-R). STUDY DESIGN This was a retrospective review of newly diagnosed pediatric patients with hypertrophic cardiomyopathy, LQTS, CPVT, and ALCA-R referred for cardiac evaluation at 6 US centers from 2008 to 2014. RESULTS A total of 450 patients (257 male/193 female; median age 10.1 years [3.6-13.8 years, 25th-75th percentiles]) were enrolled. Patient age was ≤13 years for 70.4% of the cohort (n = 317). Sudden cardiac arrest was the initial presentation in 7%; others were referred on the basis of abnormal or suspicious family history, personal symptoms, or physical findings. Patients with LQTS and hypertrophic cardiomyopathy were referred most commonly because of family history concerns. ALCA-R was most likely to have abnormal signs or symptoms (eg, exercise chest pain, syncope, or sudden cardiac arrest). Patients with CPVT had a high incidence of syncope and the greatest incidence of sudden cardiac arrest (45%); 77% exhibited exercise syncope or sudden cardiac arrest. This study demonstrated that suspicious or known family history plays a role in identification of many patients ultimately affected by 1 of the 3 genetic disorders (hypertrophic cardiomyopathy, LQTS, CPVT). CONCLUSION Important patient and family history and physical examination findings may allow medical providers to identify many pediatric patients affected by 4 cardiac disorders predisposing to sudden cardiac arrest.
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Affiliation(s)
- Aarti Dalal
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Richard J Czosek
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joshua Kovach
- Children's Hospital of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Johannes C von Alvensleben
- C.S. Mott Children's Hospital, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI; Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Santiago Valdes
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Susan P Etheridge
- Primary Children's Hospital, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael J Ackerman
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Debbie Auld
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Jeryl Huckaby
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Courtney McCracken
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Robert Campbell
- Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
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Saboo SS, Juan YH, Khandelwal A, George E, Steigner ML, Landzberg M, Rybicki FJ. MDCT of congenital coronary artery fistulas. AJR Am J Roentgenol 2014; 203:W244-52. [PMID: 25148180 DOI: 10.2214/AJR.13.12026] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this article is to describe the evaluation of congenital coronary artery fistulas (CAFs) with MDCT angiography with ECG gating (MDCTA), including the clinical manifestations, scanning techniques, differential diagnosis, and other imaging methods that may be used. CONCLUSION Congenital CAFs are rare coronary artery anomalies of termination. MDCTA is a first-line modality for pretreatment planning, and imaging findings should be recognized because CAFs may be detected incidentally.
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Abstract
Congenital coronary artery anomalies are present at birth, but most anomalies are discovered as incidental findings during coronary angiography or at autopsy. Double right coronary artery (RCA) is a rare coronary anomaly. Double RCA with bifurcation stenosis in association with degenerative complete heart block (CHB) have never been reported in literature to the best of our knowledge. We therefore report an interesting case of a patient with double RCA and degenerative CHB.
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Affiliation(s)
- A K Singh
- Interventional cardiologist, Heritage Hospital, Varanasi, India
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