Abstract
BackgroundAnomalous coronary artery originating from the opposite sinus of Vasalva with interarterial course (ACAOS-IAC) is associated with sudden cardiac death (SCD) in young athletes. If identified in adulthood prognosis is usually more benign, resulting in a dilemma regarding revascularization. MethodsThis is a retrospective observational single-center study, including adults with ACAOS-IAC. Medical records between 2012 and 2019 were reviewed for management approach, mortality, cardiac death and coronary related adverse events. Coronary computed tomographic angiography (CCTA) were reviewed. We provide a literature review in regard to clinical outcome. ResultsWe identified 40 patients with ACAOS-IAC (mean age 51). Presentation was acute in 7/40 (18%). Ischemia detection with single photon emission tomography (SPECT), cardiac magnetic resonance (CMR) or dobutamine stress echocardiography were performed in 25/40 (63%) patients. Ischemia in the vascular territory of the anomaly was present in 2/25 (8%). In 39/40 (98%) patients were treated expectative. During median follow-up of 2.7 years (IQR 1.5–5.3) no cardiovascular death was observed. Mortality occurred in 1/40 (3%) and coronary related adverse events in 2/40 (5%). We identified 20 studies describing 1194 patients. Revascularization was performed in 376/1154 (32.6%) patients. Mortality stratified for clinical management was 23/431 (5.3%) in the non-revascularization versus 16/253 (6.3%) in the revascularization group during 4.0 years follow-up (weighted median). Cause of death was cardiovascular in 10/596 (1.7%) in 4.2 years (weighted median) follow up. ConclusionsBoth revascularization and non-invasive management have good prognosis in adults with ACAOS-IAC during early follow up. There is need for guidelines and long-term surveillance.
Highlights
Anomalous origin of the coronary artery originating from the opposite sinus of Valsalva with an interarterial course (ACAOS-IAC) between the aorta and pulmonary artery is a rare congenital cardiac abnormality
Emergency ICA was performed which showed a left ACAOS-IAC and suspicion of a dissected interarterial segment which was treated with PCI
Post-procedure Coronary computed tomographic angiography (CCTA) showed proximal from the coronary stent tapering of the anomalous coronary artery either due to residual dissection or proximal intramural course
Summary
Anomalous origin of the coronary artery originating from the opposite sinus of Valsalva with an interarterial course (ACAOS-IAC) between the aorta and pulmonary artery is a rare congenital cardiac abnormality. ACAOS-IAC is often classified as malignant because it is associated with sudden cardiac death (SCD) in young athletes [2]. Identification of this coronary anomaly in adults is believed to be usually more benign but long-term follow-up is missing. Criteria for the necessity of surgical treatment in adults remain controversial and existing guidelines are not always being followed [3,4,5] This is a rare congenital anatomic variant, findings are likely to increase due to a more widespread use of coronary computed tomographic angiography (CCTA). Anomalous coronary artery originating from the opposite sinus of Vasalva with interarterial course (ACAOS-IAC) is associated with sudden cardiac death (SCD) in young athletes.
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