Anomalous Connections Of Coronary Arteries Research Articles

Anomalous connection of the circumflex coronary artery to the pulmonary trunk in a patient with Taussig–Bing anomaly: a case report

Coronary anomalies are present in one-third of all patients with transposition of the great arteries (TGA) and have been associated with increased risk of adverse outcomes after the arterial switch operation. Therefore, knowledge about coronary anatomy remains key. A 5-day-old girl with prenatal diagnosis of Taussig-Bing anomaly (double outlet right ventricle with TGA and large subpulmonary ventricular septal defect) along with aortic arch hypoplasia and coarctation of the aorta underwent the arterial switch operation with closure of the ventricular septal defect and aortic arch repair. On preoperative echocardiography, the right (R) and left coronary artery (LCx) connected both to aortic sinus 1, suggesting 1RLCx coronary anatomy according to the Leiden Convention coronary coding system. However, intraoperative inspection led to a reclassification of the coronary anatomy: the right coronary artery and left anterior descending coronary artery connected to aortic sinus 1 (1RL) as had been observed on echocardiography, but-remarkably-the circumflex coronary artery (Cx) connected to the posterior sinus of the pulmonary trunk. As a consequence, cardioplegia was administered into both the aortic and pulmonary roots, and the circumflex coronary artery could stay in its native position without having to be transferred during the arterial switch operation. Various disruptions during embryological development can lead to unusual coronary anatomy in TGA patients. While anomalous connection of a coronary artery to the pulmonary trunk remains exceedingly rare, care should be taken to identify this pattern when present as failure to do so may result in adverse outcomes.

Anomalous Connection of the Coronary Artery Causing ST Segment Elevation Myocardial Infarction: A Case Report

Background: With an angiographic prevalence approaching 1%, Anomalous connections of the Coronary arteries (ANOCOR) are rare. The term connection is preferred over origin since the coronary arteries do not grow out of the aorta but grow into the aorta from the peri truncal ring of coronary arterial vasculature. Very often these anatomical shapes are incidental findings without clinical impact; however, in some specific cases, clinical symptoms may occur arriving to sudden cardiac death (SCD), this is particularly true when there is a an interarterial course between the ascending aorta and the pulmonary.
 Case Presentation: This case is about patient that we receive in emergency department presenting with an inferior ST segment elevation myocardial infarction (STEMI) which was found to be caused by compression of the proximal right coronary artery (RCA) between the aorta and the pulmonary trunk. Surgery was indicated by the heart team for the treatment of this condition.
 Conclusions: This case presents a severe manifestation of proximal anomalous connection of the right coronary artery with a “malignant” course between the aorta and the pulmonary artery. This variant has been called malignant because of its association with sudden death especially in young asymptomatic athletes. In current guidelines for symptomatic ANOCOR with interarterial course the treatment recommended is surgery.

Hemodynamic and clinical impact in adult patients with anomalous aortic origin of the coronary artery evaluated with quantitative flow reserve

Anomalous origin of the right coronary artery (ARCA) represents the most frequent form of abnormal coronary origin and may potentially increase the risk for sudden cardiac death. Evaluation of ARCA in adult patients referred for invasive coronary angiograms (ICA) is difficult, and clinical impact is unknown. Quantitative flow reserve (QFR) is an available method able to virtually calculate fractional flow reserve using 3-dimensional quantitative coronary angiography (3D-QCA) based on ICA. To evaluate the feasibility of QFR analysis in patients with ARCA and its clinical impact. Using the registry of proximal anomalous connections of coronary arteries (ANOCOR registry), a multicentric observational registry including 472 adult patients with ANOCOR between 2010 and 2013, we retrospectively performed QFR analysis from ICA and evaluated the rate of death, myocardial infarction, unplanned revascularization and hospitalization in cardiology at 5 years. Among 128 patients with ARCA, 41 (32%) could have QFR analysis with median clinical follow-up of 8.3 years. The mean QFR value was 0.90 ± 0.10, and 3D-QCA analysis showed preserved lumen area despite the elliptical shape of the proximal part of the ARCA which in the worst cases appeared on ICA as a significant narrowing. The event rate was 14.6% ( n = 6), including three deaths (one due to cancer, one due to stroke, and one cause remains unknown), two unplanned revascularizations, and one hospitalization for heart failure at 5 years. No myocardial infarction was reported ( Fig. 1 ). QFR analysis of ARCA is feasible and non-significant QFR values are associated with good clinical outcome at 5 years. QFR of ARCA could be the evaluation of choice to help in clinical decision-making during ICA, when applicable.

P3652Hemodynamic and clinical impact of ANOmalous connections of CORonary arteries using computed tomography-derived Fractional Flow Reserve (FFRCT) from the ANOCOR registry

Abstract Background With the emergence of coronary computed tomography angiography (CCTA), ANOmalous connections of CORonary arteries (ANOCOR) are more frequently diagnosed than previously reported. CT-derived Fractional Flow Reserve (FFRCT) is a non-invasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features could help for the management of patients with ANOCOR. Objective We aimed to retrospectively evaluate the clinical impact of FFRCT analysis in the ANOCOR registry population with 3 year-follow-up. Method The ANOCOR registry included adult patients with ANOCOR detected during invasive coronary angiogram or CCTA performed between January 2010 and January 2013. Among 472 patients included, 105 patients had a cardiac CT during the inclusion period. Results We retrospectively performed FFR-CT and obtained successful analyses in 54 patients of 60±13 years with a complete 3-year clinical follow-up. Thirty-six (67%) patients had conservative treatment and 18 (33%) patients had coronary revascularization after the CCTA. FFRCT analysis showed that ANOCOR course slightly reduces the mean FFRCT value of 1 at the ostium to 0.90±0.10 downstream the abnormal course and had a distal vessel mean FFRCT value 0.82±0.11. No statistical difference of FFRCT values were observed between ANOCOR at risk and non at risk and between conservative and revascularization groups. At 3 years of follow-up, only one patient had unplanned revascularizations of ANOCOR vessel in the conservative strategy group. Conclusion We observed favorable FFRCT values of ANOCOR and non ANOCR vessels. Patients treated conservatively and revascularized had excellent clinical outcome at 3 years of follow up.

P2736Hemodynamic and clinical impact in adult patients with anomalous aortic origin of the coronary artery evaluated with quantitative flow reserve

Abstract Background Anomalous origin of the right coronary artery (ARCA) represents the most frequent form of abnormal coronary origin and may potentially increase the risk for sudden cardiac death. Evaluation of ARCA in adult patients referred for invasive coronary angiograms (ICA) is difficult, and clinical impact is unknown. Quantitative flow reserve (QFR) is an available method able to virtually calculate fractional flow reserve using 3-dimensional quantitative coronary angiography (3D-QCA) based on ICA. Objectives To evaluate the feasibility of QFR analysis in patients with ARCA and its clinical impact. Methods Using the registry of proximal anomalous connections of coronary arteries (ANOCOR registry), a multicentric observational registry including 472 adult patients with ANOCOR between 2010 and 2013, we retrospectively performed QFR analysis from ICA and evaluated the rate of death, myocardial infarction, unplanned revascularization and hospitalization in cardiology at 5 years. Results Among 128 patients with ARCA, 41 (32%) could have QFR analysis with median clinical follow-up of 8.3 years. The mean QFR value was 0.90±0.10, and 3D-QCA analysis showed preserved lumen area despite the elliptical shape of the proximal part of the ARCA which in the worst cases appeared on ICA as a significant narrowing. The event rate was 14.6% (n=6), including three deaths (one due to cancer, one due to stroke, and one cause remains unknown), two unplanned revascularizations, and one hospitalization for heart failure at 5 years. No myocardial infarction was reported. Conclusions QFR analysis of ARCA is feasible and non-significant QFR values are associated with good clinical outcome at 5 years. QFR of ARCA could be the evaluation of choice to help in clinical decision-making during ICA, when applicable.

87Evaluation of the hemodynamic impact of different forms of anomalous connection of coronary artery using Computed Tomography derived Fractional Flow Reserve

87Evaluation of the hemodynamic impact of different forms of anomalous connection of coronary artery using Computed Tomography derived Fractional Flow Reserve

P1786Evaluation of the hemodynamic impact of different forms of anomalous connection of coronary artery using Computed Tomography derived Fractional Flow Reserve

P1786Evaluation of the hemodynamic impact of different forms of anomalous connection of coronary artery using Computed Tomography derived Fractional Flow Reserve

Anomalous connection of the right coronary artery with interarterial course: Preliminary prospective experience of stenting in a selected adult population

Anomalous connections of the coronary arteries (ANOCOR) with interarterial course raise therapeutic problems. Current guidelines recommend a surgical repair for right ANOCOR with evidence of ischemia. The lack of controlled studies and the scarcity of long-term data may explain an underutilization of surgical treatment. A percutaneous approach may provide an interesting alternative in a selected adult population. To assess the feasibility and safety of preaortic segment stenting in right ANOCOR with interarterial course. Stenting was proposed according to predefined criteria (age > 30 years, symptoms or documented ischemia, no history of aborted sudden death, ostial ovoid shape) for patients referred to an expert group. All patients underwent selective coronary angiography and coronary computed tomography. Evaluation by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was recommended. Ten patients were prospectively included between 2014 and 2016, mean age 56 years (35–81). Two patients had acute coronary syndrome, five had stable angina, two were asymptomatic with positive stress test and one had syncope. An intramural segment was identified in half of the patients. Stenting was successful with residual angiographic stenosis < 50% in all procedures, 90% of drug-eluting stents, mean fluoroscopic time of 18 min, 70% of IVUS or OCT guidance, mean troponin at 24 hours of 0.58 μg/L and no periprocedural complication. Follow-up at 6 months was uneventful in all but one patient requiring a new hospitalization at 5 months for persistent angina reported to a vasospastic angina ( Fig. 1 ). Preaortic segment stenting of right ANOCOR with interarterial course appears feasible and safe in this preliminary experience. A longer follow-up and a more important population are needed to know whether this technique is suitable for a next therapeutic algorithm.

Aortic Implantation for Anomalous Connection of the Coronary Artery to the Pulmonary Artery in Older Children and Adults.

Background Anomalous connection of the coronary artery to the pulmonary artery (ACAPA) has a low incidence rate in older children and adults. The aim of this article was to evaluate the outcome of treating ACAPA with aortic implantation in older children and adults. Methods We included 21 patients (9 children and 12 adults) with ACAPA in our hospital between January 1991 and January 2015. Among these patients, 19 had anomalous connection of the left coronary artery to the pulmonary artery, 2 had anomalous connection of the right coronary artery to the pulmonary artery (ARCAPA). All of the patients underwent aortic implantation, aged 4 to 62 years (median, 18). The mean left ventricular ejection fraction (LVEF) was 55.9 ± 7.6% (<50% in 4). Eleven patients underwent direct aortic implantation (including two ARCAPAs), while 10 patients underwent tubular implantation. Eleven patients had varying degrees of mitral regurgitation, while mitral valve plasty or replacement was performed in six patients (severe mitral regurgitation) concurrently. Results There was no early mortality. Follow-up observation was performed in all 21 patients, with a mean follow-up time of 6.4 ± 5.6 years (ranging from 0.5 to 23 years). Two patients died due to noncardiac reasons 1 and 10 years after operation, respectively. Seven patients had mild mitral regurgitation, while no patients had moderate or severe mitral regurgitation after operations. The postoperative mean LVEF was not improved at 54.7 ± 7.0%, p > 0.05. Conclusion Among the multiple surgical strategies for the treatment of ACAPA, aortic implantation was used commonly in older children and adults, while mitral valve repair can be performed concurrently.

EComment. Combined surgical strategies for anomalous connection of coronary artery to pulmonary artery in adults.

eComment. Combined surgical strategies for anomalous connection of coronary artery to pulmonary artery in adults.

Ostium coronaire unique : artère coronaire unique ou artère coronaire ectopique connectée à l’artère controlatérale. Comment et pourquoi les différencier ?

Among the wide spectrum of congenital abnormalities of coronary arteries, a single coronary artery is often confused with an ectopic coronary artery connected with the contralateral coronary artery. Both abnormalities are characterized by a single coronary ostium, but they differ by the lack or not of an initial ectopic course. The prognosis of anomalous connections of coronary arteries depends mainly on the type of the initial course in relation to other cardiac structures. Therefore, the distinction between a single coronary artery and an ectopic coronary artery connected with the contralateral artery is of importance.