Abnormal origin of the coronary arteries by echocardiography. And then what?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The anomalous origin of the coronary arteries from the opposite sinus (AOCA) is increasingly recognized. The most frequent diagnosed by echocardiography is the circumflex artery arising from the right sinus of Valsalva with a retroaortic course. Classically is believed to be a low-risk malformation, nevertheless, whether this anomaly is associated with other high risk features (coexistence with other high-risk AOACA, acute take off angle, intramural course, etc) not easily identify by echocardiography is unknown. Objectives The objectives of this study are to know the prevalence of anomalies of the origin of the coronary arteries diagnosed by echocardiography, to determine the use of additional diagnostic tests and to evaluate the coexistence of the anomalous origin of the circumflex artery with other anomalies and / or risk characteristics. Materials and methods A retrospective search of AOCA diagnosis was performed among echocardiography reports of outpatients in a high complexity cardiology center between March 2018 and December 2021. The clinical history was investigated to identify if the AOCA diagnosis led to further testing (coronary Angio CT or Ischemia diagnosis test) and if these studies provided clinically relevant information. Results Of a total of 26260 echocardiogram reports investigated, 50 presented suspected AOCA (0. 2%), 49 circumflex arteries with anomalous arising from the right sinus with retroaortic course and 1 left coronary artery arising from the right sinus with a subpulmonary course. 18 coronary CT angiography (36%) and 13 stress tests (26%) were requested. In 17 of 18 patients (98%) coronary CT angiography confirmed the diagnosis of anomalous origin of circumflex artery arising from the right sinus with retroaortic course (true positive). In 4 of the 17 OAAC confirmed by CT angiography, the study provided additional important information (2 associated anomalies of the origin of the anterior descending, 1 interarterial course and 1 circumflex artery arising from the right sinus with a retroaortic course and an angle take-off from the aortic wall ‹45°). Conclusion The diagnosis of AOCA by echocardiography is an uncommon finding and most of them are low risk. The most frequent variant is the circumflex artery arising from the right sinus with a retroaortic course. CT angiography adds additional information by identifying associated abnormalities of other coronary arteries and evaluating the angulation of the origin of abnormal coronary arteries.