Abstract 11876: Instantaneous Wave-Free Ratio and Fractional Flow Reserve Are Helpful in the Assessment of Anomalous Aortic Origin of a Coronary Artery

Abstract

Background: Anomalous aortic origin of a coronary artery (AAOCA) is the second most common cause of sudden cardiac death in youth during exertion. An optimal method to risk stratify patients with AAOCA and atypical symptoms is yet to be defined. Hypothesis: Invasive intracoronary hemodynamic flow measurement can be helpful in scenarios when there is conflict between clinical presentation and non-invasive studies. Methods: Case series of patients <21 years old with AAOCA who underwent cardiac catheterization with instantaneous wave-free ratio (iFR)/fractional flow reserve (FFR) measurement at baseline and during adenosine and dobutamine infusion. Baseline iFR < 0.89 and/or FFR <0.8 were considered hemodynamically significant. All patients underwent dobutamine stress cardiac MRI to evaluate for inducible myocardial ischemia during provocative stress. Post-op assessment was described in patients who underwent surgical intervention. Results: A total of 8 patients, including 3 AAOCA of a left (AAOLCA) and 5 AAOCA of a right coronary artery (AAORCA) underwent cardiac catheterization including iFR and FFR measurement [Table]. iFR and FFR were reassuring in 4 patients, and suggestive of significantly impaired coronary flow in 2 AAOLCA and 2 AAORCA. There were no catheterization complications. Shared decision making was discussed, 2 patients with AAOLCA underwent successful surgical repair (patient 4 had normalized iFR/FFR after surgery and patient 8 is awaiting post-op assessment), and 2 are awaiting surgical scheduling. Patients not intervened upon are exercising with no restrictions, except one with concerns for cardiomyopathy. Conclusions: Invasive assessment using iFR/FFR with adenosine and dobutamine is helpful in shared decision making of AAOCA with conflicting noninvasive data and contribute to return to play after surgery. Long-term follow-up is essential to understand the predictive values of iFR/FFR in patients with AAOCA.