Anomalous Connection Research Articles

Repair of anomalous right upper pulmonary venous connection with extracardiac tunnel using pedicled autologous pericardium.

We introduce a new surgical technique where an extracardiac tunnel is created using pedicled autologous pericardium in an 8-month-old boy who was diagnosed with ventricular septal defect and anomalous connection of the right superior pulmonary vein to the superior vena cava.

Unknown Partial Anomalous Pulmonary Venous Connection Causing Arterial Blood Gases During Central Venous Catheter Insertion

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly. We report about the case with an “arterial blood gas” analysis taken from a newly inserted central venous catheter (CVC). Thoracic computed tomography (CT) verified the catheter in the left internal jugular vein. The contrast was given through the catheter which revealed a partial anomalous venous connection of the left upper pulmonary vein to the left brachiocephalic vein. PAPVC should be taken into consideration in cases of “arterial blood gases” taken from a correctly inserted CVC. Most patients are asymptomatic. Adequate diagnostic tools to detect PAPVC are TEE, CT or MRI.

Outcome of modified réparation à l'ètage ventriculaire (REV) based on anatomical characteristics for the anomalous ventriculoarterial connection with ventricular septal defect and left ventricular outflow tract obstruction.

The present study evaluated the results of the modified réparation à l'étage ventriculaire (REV) based on the individual anatomical and pathological findings of the patients with an anomalous ventriculo-arterial connection with ventricular septal defect (VSD) and left ventricular outflow tract obstruction. We reviewed a series of 24 patients who underwent modified REV between 2005 and 2019. Surgical indications included ventricles and atrioventricular valves suitable for biventricular repair, severe left ventricular outflow tract obstruction (peak gradient >30 mmHg), unrestrictive subaortic VSD and coronary arteries not suitable for reimplantation. The mean follow-up time was 7.0 ± 4.2 years (range 0.5-14.1 years). Kaplan-Meier analyses showed that overall survival was 100% and freedom from any reoperation was 93.3% ± 6.4%. Longitudinal analyses of the available postoperative echocardiographic data showed that the left ventricular outflow tract peak gradient was less than 10 mmHg in all patients (15/15) and the left ventricular ejection fraction was more than 50% in 93.3% of patients (14/15). The right ventricular outflow tract peak gradient was less than 40 mmHg in 73.3% of patients (11/15). The REV remains an option for selected patients despite the increasing use in recent years of the Nikaidoh procedure and its modifications. The surgical strategy needs to be determined by the specific anatomical and pathological findings of the patient. The modified REV had excellent long-term survival and freedom from reoperation for the treatment of anomalous ventriculo-arterial connection with VSD and left ventricular outflow tract obstruction. The long-term performance of the reconstructed left ventricular outflow tract and right ventricular outflow tract is satisfactory.

Utility of modified vascular corrosion casting technique in the diagnosis of fetal ductus arteriosus abnormalities

The anatomy of ductus arteriosus (DA) can be varied in different congenital heart defects (CHDs), and it is difficult to fully discover the DA and other associated cardiac anomalies by prenatal ultrasound. This study was aimed to use the modified vascular corrosion casting technique to prepare fetal cardiovascular casts with DA anomalies, assess the casting effectiveness in evaluating the great vessels of the fetal heart and investigate the utility of cardiovascular casting for the demonstration of fetal DA abnormalities. This retrospective study enrolled fourteen fetuses (23 to 28+2 gestational weeks) with severe CHDs diagnosed by prenatal echocardiography and casting technique from January 2013 to July 2019. The sonographic features of DAs were carefully observed and other associated cardiovascular anomalies were also evaluated during the screening. The architectures of DAs and the whole cardiovascular system were observed and analyzed, and then the cast findings were compared with prenatal ultrasonic results. In fourteen cases, 18 ductal abnormities were indicated by prenatal echocardiography in fourteen cases, while 25 were revealed by casting. Cast findings included 4 cases of ductal stenosis, 1 case of ductal dilation, 6 cases of ductal circuity, 3 cases of right-sided ductus, 5 cases of anomalous ductal connection, 1 case of bilateral ductus and 5 cases of absent ductus. Cast findings consisted with ultrasound in 10 ductal abnormalities, revealed additional 15 ductal abnormalities miss-diagnosed by sonography, and corrected 6 abnormalities misdiagnosed prenatally. Meanwhile, 3 ductal abnormalities (reversed flow) could not be demonstrated by casts but only by ultrasound. Cast models can visually display the anatomical characteristics of ductus arteriosus, and could be successfully used in the demonstration of ductus abnormalities in fetuses with severe CHDs. Comparing with ultrasound, casting technique has its own superiority in exhibiting ductus abnormalities, especially in certain types such as course, origin and absence abnormalities of ductus.

Life-threatening and major cardiac events during long-distance races: updates from the prospective RACE PARIS registry with a systematic review and meta-analysis.

Limited data exist regarding the incidence and aetiology of life-threatening events such as major cardiac events or exertional heat stroke during long-distance races. We aimed to provide an updated incidence, etiology and prognosis of life-threatening events during long-distance races. The prospective RACE PARIS registry recorded all life-threatening events/fatal events occurring during 46 marathons, half-marathons and other long-distance races in the Paris area between 2006 and 2016, comprising 1,073,722 runners. Event characteristics were determined by review of medical records and interviews with survivors. The incidence of life-threatening events, exertional heat stroke and major cardiac events was 3.35 per 100,000, 1.02 per 100,000 and 2.33 per 100,000, respectively, including 18 sudden cardiac arrests (1.67 per 100,000). The main aetiology of sudden cardiac arrest was myocardial ischaemia (11/18), due to acute coronary thrombosis (6/11), stable atherosclerotic coronary artery disease (2/11), coronary dissection (1/11), anomalous connection (1/11) or myocardial bridging (1/11). A third of participants with ischaemia-related major cardiac events presented with pre-race clinical symptoms. Major cardiac events were more frequent in the case of a high pollution index (6.78 per 100,000 vs. 2.07 per 100,000, odds ratio 3.27, 95% confidence interval 1.12-9.54). Case fatality was low (0.19 per 100,000). Similarly, we report in a meta-analysis of eight long-distance race registries comprising 16,223,866 runners a low incidence of long-distance race-related sudden cardiac arrest (0.82 per 100,000) and fatality (0.39 per 100,000). Death following sudden cardiac arrest was strongly associated with initial asystole or pulseless rhythm. Long-distance race-related life-threatening events remain rare although serious events. Better information for runners on the risk of pre-race clinical symptoms, outside air pollution and temperature may reduce their incidence.

Sinus Pericranii in Posterior Cranial Vault Distraction.

Anomalous venous connections between the extracranial and intracranial systems are relatively rare. These connections are also known as sinus pericranii (SP) have been reported previously in the setting of various cranial malformations including craniosynostosis. Angiography may be useful in the diagnosis of SP also allowing for differentiation of the dominance of the venous systems. Several methods have been described in the treatment of SP. In isolated cases both endovascular and open approaches have been successful in the treatment of SP. In cases wherein there is synostosis present, both single- and multiple-staged operations have been described. In this article, we describe 2 cases of posterior cranial distraction in the setting of sinus peri cranii.

A Review of the Surgical Management of Anomalous Connection of the Right Superior Caval Vein to the Morphologically Left Atrium and Biatrial Drainage of Right Superior Caval Vein.

The present perspective is a synthesis of published investigations in the setting of anomalous connection of the right superior caval vein to the morphologically left atrium or biatrial drainage of the right caval vein. We identified 57 suitable cases from 97 investigations, reviewing the clinical presentation, diagnostic modalities utilized, surgical techniques used, and their outcomes. Clinical presentation, radiographic findings, saline contrast echocardiography, computed tomographic angiocardiography, radionuclide perfusion scan, magnetic resonance imaging, and angiocardiography provided the diagnostic information and were used to define the disease entities before surgery. We have also addressed several issues concerning the influence of the so-called heterotaxy: the establishment of the diagnosis, the variation in clinical presentation, and subsequent management. For the overall group of patients undergoing either surgical intervention or transcatheter treatment with an Amplatzer vascular plug, the operative mortality remains high at 9.5%. We submit that an increased appreciation of these disease entities will contribute to improved future surgical management.

TTTS-STgan: Stacked Generative Adversarial Networks for TTTS Fetal Surgery Planning Based on 3D Ultrasound.

Twin-to-twin transfusion syndrome (TTTS) is characterized by an unbalanced blood transfer through placental abnormal vascular connections. Prenatal ultrasound (US) is the imaging technique to monitor monochorionic pregnancies and diagnose TTTS. Fetoscopic laser photocoagulation is an elective treatment to coagulate placental communications between both twins. To locate the anomalous connections ahead of surgery, preoperative planning is crucial. In this context, we propose a novel multi-task stacked generative adversarial framework to jointly learn synthetic fetal US generation, multi-class segmentation of the placenta, its inner acoustic shadows and peripheral vasculature, and placenta shadowing removal. Specifically, the designed architecture is able to learn anatomical relationships and global US image characteristics. In addition, we also extract for the first time the umbilical cord insertion on the placenta surface from 3D HD-flow US images. The database consisted of 70 US volumes including singleton, mono- and dichorionic twins at 17-37 gestational weeks. Our experiments show that 71.8% of the synthesized US slices were categorized as realistic by clinicians, and that the multi-class segmentation achieved Dice scores of 0.82 ± 0.13, 0.71 ± 0.09, and 0.72 ± 0.09, for placenta, acoustic shadows, and vasculature, respectively. Moreover, fetal surgeons classified 70.2% of our completed placenta shadows as satisfactory texture reconstructions. The umbilical cord was successfully detected on 85.45% of the volumes. The framework developed could be implemented in a TTTS fetal surgery planning software to improve the intrauterine scene understanding and facilitate the location of the optimum fetoscope entry point.

Successful Repair of Coarctation of the Aorta and Obstructive Total Anomalous Pulmonary Veins Connection in a One-Day-Old Newborn

Abstract A clinical case of successful repair of a combination of total anomalous pulmonary venous connection (TAPVC) with collector stenosis in one-day-old newborn. Only one case of successful correction of such a pathology is reported previously. The operation was performed with cardiopulmonary bypass and temporary antegrade brain perfusion. The narrowed aortic area was resected, the integrity of the aortic arch was restored using an extended anastomosis, and TAPVC correction was performed using a “sutureless technique”. The postoperative period was uneventful. The newborn was discharged from hospital on the 12th day.

Atrophic Corpus Callosum Associated with Altered Functional Asymmetry in Major Depressive Disorder.

PurposeImpairments in intra- and inter-hemispheric information transfer circuits have been reported in patients with major depressive disorder (MDD). However, the specific anomalous connection (intra- and/or inter-hemispheric) and hemisphere (left and/or right) in which this connection plays a more dominant role in the pathogenic mechanism underlying MDD are still poorly understood.Patients and MethodsStructural magnetic resonance imaging and resting-state functional magnetic resonance imaging were performed in 33 patients with MDD and 33 healthy controls. The intra- and inter-hemispheric functional connectivity (FC) strength in the default mode network areas and volume of the callosal subregions were computed using independent samples t-tests. The partial correlations between the volumes and FCs were also computed.ResultsThe patients with MDD had smaller volumes in the genu of the corpus callosum than the controls. The intrahemispheric FCs of the bilateral posterior cingulate gyrus, left precuneus, left medial superior frontal gyrus, left medial orbitofrontal gyrus, left angular gyrus and left middle temporal gyrus, and interhemispheric FCs of the bilateral posterior cingulate gyrus in the patients with MDD were lower than those in the controls. Moreover, the intrahemispheric FCs of the precuneus and interhemispheric FCs of middle frontal gyrus, orbital middle frontal gyrus, and anterior cingulate gyrus in the patients with MDD showed right-lateralized asymmetry, which were opposite from the asymmetry patterns observed in the controls. The functional asymmetry of the anterior cingulate gyrus was correlated with the volume of the genu of the corpus callosum and disease duration.ConclusionThese findings provide robust evidence that intra- and inter-hemispheric disconnections are involved in MDD, and that functional disruptions in the left hemisphere may be more relevant to the pathophysiology of MDD. Furthermore, imbalanced interhemispheric exchanges may contribute to the anatomical deficits in the corpus callosum in patients with MDD.

A diver\u2019s dilemma \u2013 a case report on bronchopulmonary sequestration

BackgroundAn asymptomatic SCUBA (Self-contained underwater breathing apparatus) diver was discovered to have an intralobar bronchopulmonary sequestration during routine pre-course screening. This is the first reported case of a diver who, having previously completed several recreational and military diving courses, was subsequently diagnosed with a congenital lung condition, possibly contraindicating diving. Presently, there is no available literature providing guidance on the diving fitness of patients with such a condition.Case presentationAn asymptomatic 26-year-old male diver was nominated to attend an overseas naval diving course. Prior to this, he had been medically certified to participate in, and had successfully completed other military and recreational diving courses. He had also completed several hyperbaric dives up to a depth of 50 m and 45 recreational dives up to a depth of 30 m. He did not have a history of diving-related injuries or complications. He had never smoked and did not have any medical or congenital conditions, specifically recurrent respiratory infections. As part of pre-course screening requirements, a lateral Chest X-ray was performed, which revealed a left lower lobe pulmonary nodule. This was subsequently diagnosed as a cavitatory left lower lobe intralobar bronchopulmonary sequestration on Computed Tomography Thorax. The diver remains asymptomatic and well at the time of writing and has been accepted to participate in another overseas course involving only dry diving in a hyperbaric chamber, with no prerequisites for him to undergo surgery.ConclusionAlthough bronchopulmonary sequestrations lack communication with the tracheobronchial tree, they may still contain pockets of air, even if not radiologically visible. This can be attributed to anomalous connections which link them to other bronchi, lung parenchyma and/or pores of Kohn. As such, there is a higher theoretical risk of pulmonary barotrauma during diving, leading to pneumothorax, pneumomediastinum, or cerebral arterial gas embolism. Taking these into consideration, the current clinical consensus is that bronchopulmonary sequestrations and all other air-containing lung parenchymal lesions should be regarded as contraindications to diving. Patients who have undergone definitive and uncomplicated surgical resection may be considered fit to dive.

Presentation, stabilisation and contrast‐enhanced computed tomographic (CT) diagnosis of a left gastrocaval portosystemic shunt in a pony foal

SummaryA 2‐week‐old pony foal was presented for recurrence of neurological dysfunction, obtunded‐comatose mentation and collapse. Signalment, history, haematological and clinical chemical measurements and response to treatment prompted a presumptive diagnosis of hepatic encephalopathy secondary to a portosystemic shunt. This case differs from previous reported cases of congenital portosystemic shunts in horses due to the early onset of clinical signs, which usually occur at 2–6 months of age. In addition, in comparison with previously reported cases, this foal stabilised rapidly with minimal intervention. Contrast‐enhanced computed tomography (CT) confirmed a left gastrocaval extrahepatic portosystemic shunt. Surgical intervention was not attempted due to financial constraints, so the foal was subjected to euthanasia, and on post‐mortem examination, the anomalous vascular connection could clearly be identified.

Norwood procedure with right ventricle to pulmonary artery conduit: a single-centre 20-year experience.

The aim of this study was to evaluate the long-term outcomes of the Norwood procedure with right ventricle-pulmonary artery (RV-PA) conduit for hypoplastic left heart complex. A retrospective observational study was performed in 136 patients with hypoplastic left heart complex who underwent a Norwood procedure with RV-PA conduit between 1998 and 2017. The probabilities of survival, reintervention and Fontan completion were analysed. Stage 1 survival was 91.9% (125/136). Reintervention for PA stenosis was needed for 22% and 30% at stages 2 and 3, respectively, while 15% underwent reintervention for aortic arch recoarctation. Among 106 bidirectional Glenn survivors, 93 (68% of the total number of patients) had a Fontan completion, while 4 were not considered to be Fontan candidates. Risk factors for overall mortality included weighing <2.5 kg at the time of the Norwood procedure, intact atrium septum, total anomalous pulmonary vein connection and more than mild atrioventricular regurgitation at the time of the Norwood procedure. Overall survival was 80.9%, 72.3% and 62.8% at 1, 5 and 20 years, respectively. Probabilities of survival and Fontan completion were acceptable under the current surgical strategy incorporating RV-PA Norwood procedure as the first palliation. Incorporating a strategy to maintain PA growth and ventricular function through the staged repair is of prime importance. Further studies are necessary to observe changes in atrioventricular regurgitation as well as in right ventricular function, in patients who require atrioventricular valve interventions during the staged Fontan completion.

Progression of vascular remodeling in pulmonary vein obstruction

ObjectivesPulmonary vein obstruction (PVO) frequently occurs after repair of total anomalous pulmonary vein connection with progression of intimal hyperplasia from the anastomotic site toward upstream pulmonary veins (PVs). However, the understanding of mechanism in PVO progression is constrained by lack of data derived from a physiological model of the disease, and no prophylaxis has been established. We developed a new PVO animal model, investigated the mechanisms of PVO progression, and examined a new prophylactic strategy. MethodsWe developed a chronic PVO model using infant domestic pigs by cutting and resuturing the left lower PV followed by weekly hemodynamic parameter measurement and angiographic assessment of the anastomosed PV. Subsequently, we tested a novel therapeutic strategy with external application of rapamycin-eluting film to the anastomotic site. ResultsWe found the pig PVO model mimicked human PVO hemodynamically and histopathologically. This model exhibited increased expression levels of Ki-67 and phospho-mammalian target of rapamycin in smooth muscle-like cells at the anastomotic neointima. In addition, contractile to synthetic phenotypic transition; that is, dedifferentiation of smooth muscle cells and mammalian target of rapamycin pathway activation in the neointima of upstream PVs were observed. Rapamycin-eluting films externally applied around the anastomotic site inhibited the activation of mammalian target of rapamycin in the smooth muscle-like cells of neointima, and delayed PV anastomotic stenosis. ConclusionsWe demonstrate the evidence on dedifferentiation of smooth muscle-like cells and mammalian target of rapamycin pathway activation in the pathogenesis of PVO progression. Delivery of rapamycin to the anastomotic site from the external side delayed PV anastomotic stenosis, implicating a new therapeutic strategy to prevent PVO progression.

Anomalous intrinsic connectivity within and between visual and auditory networks in major depressive disorder

ObjectiveMajor depressive disorder (MDD) is a ubiquitous mental illness with heterogeneous symptoms, however, the pathophysiology mechanisms are still not fully understood. Clinical and preclinical studies suggested that depression could cause disturbances in sensory perception systems, disruptions in auditory and visual functions may serve as an essential clinical features underlying MDD. MethodsThe current study investigated the abnormal intrinsic connectivity within and between visual and auditory networks in 95 MDD patients and 97 age-, gender-, education level-matched healthy controls (HCs) by using resting-state functional magnetic resonance imaging (fMRI). One auditory network (AN) and three visual components including visual component 1 (VC1), VC2, and VC3 were identified by using independent component analysis method based on the fMRI networks during the resting state with the largest spatial correlations, combining with brain regions and specific network templates. ResultsWe found that MDD could be characterized by the following disrupted network model relative to HCs: (i) reduced within-network connectivity in the AN, VC2, and VC3; (ii) reduced between-network connectivity between the AN and the VC3. Furthermore, aberrant functional connectivity (FC) within the visual network was linked to the clinical symptoms. ConclusionsOverall, our results demonstrated that abnormalities of FC in perception systems including intrinsic visual and auditory networks may explain neurobiological mechanisms underlying MDD and could serve as a potential effective biomarker.

Self-Compassion as a Mediator in the Effect of Dispositional Mindfulness on Anxiety and Aggressiveness in College Students with Left-Behind Experience

Coronary artery fistulae (CAFs) are anomalous connections that bypass the myocardial capillary bed between 1 or more coronary arteries and other cardiac chambers or other vessels. These fistulae are usually asymptomatic a... | Find, read and cite all the research you need on Tech Science Press

606 Formation of Coronary Artery Fistula After Mitral Valve Repair

We report a case of a 72-year-old male, who was incidentally found to have developed a coronary artery fistula (CAF) following cardiac surgery. The patient had undergone mitral valve (MV) repair, left atrial appendage excision and AF ablation for management of mitral regurgitation secondary to bileaflet MV prolapse 3 years prior. He reported intermittent exertional dyspnoea and underwent coronary angiography following an abnormal exercise stress test. At coronary angiography, a CAF between the right atrial branch artery of the right coronary artery (RCA) and the right atrium was demonstrated. No CAF was present on angiography preoperatively. As there was no echographic evidence of haemodynamic significance, the CAF was managed conservatively. The cause of CAF formation at this specific site is hypothesised to be due to injury to the right atrial branch artery by cannulation of the right atrium for cardiopulmonary bypass, a rarely described occurrence in the literature [[1]Lee R.M. Colucci G. W Coronary artery fistula after mitral valve surgery.American Heart Journal. 1988; 115: 1128-1130Crossref PubMed Scopus (17) Google Scholar]. Coronary artery fistulae are anomalous connections between the coronary arteries and other vessels or cardiac chambers (coronary-cameral fistula). The population incidence is estimated at 0.2% and is most often due to a congenital malformation. Invasive procedures including coronary angiography and cardiac surgery are known to cause CAF. The incidence of CAF in the post cardiac surgery population has been reported in case series of up to 2.3% post coronary artery bypass grafting (CABG) and 8.9% following CABG and valve surgery [[2]Young A, Cheng R, Wei J, Esmailian F, Currier J, Azarbal B. Prevalence of coronary artery fistulae after cardiac surgery. Comparison between coronary artery bypass grafting, valve surgery, and orthotopic heart transplantation. Herz 2015;40 Suppl 1:51-5.Google Scholar]. Importantly, this case highlights that CAF can occur, following cardiac surgery, at a site distant to the operative region.

Descending aortopulmonary vein fistula: an unusual cause of recurrent hemoptysis in a young female: a case report

Background: Hemoptysis is an alarming symptom. Its etiology may vary from mild infections to malignancies. Pulmonary infections are a common cause of hemoptysis in young adults. However, vascular malformations are also enlisted among the sources of hemoptysis. Case Presentation: A 33-year-old female presented to the institute with hemoptysis. The etiology of hemoptysis was ascertained to be an anomalous vascular connection between the descending aorta and inferior pulmonary vein draining into the left atrium. Conclusion: Descending aortopulmonary fistula (DAPVF) is a rare congenital vascular malformation representing a left-toleft shunt, and cardiac failure is a presenting feature as described in some reported cases in children. DAPVF may present as hemoptysis in adults.

P718 Unexpected finding during follow up for a suspected arrythmogenic right ventricular cardiomyopathy (ARVC)

Abstract Interatrial communication is the most common congenital defect found in adulthood, being the most common ostium secundum variety (70-80%). Superior and inferior sinus venosus defects are less usual, found in the 5-10% of cases of interatrial communication and frequently associated with anomalous pulmonary venous return (APVR). These defects are located near the junction of the superior (5%) or inferior (&amp;lt;1%) vena cava with the right atrium, which makes them difficult to diagnose by transthoracic ecocardiography (TTE). Case description: A 44-year-old man who is being followed up in our electrophysiology consulting with suspicion of ARVC (suggestive CMR with no gene found) after an episode of ventricular tachycardia (VT) 11 years ago. Asymptomatic since then under treatment with atenolol, except for an episode of chest pain that required a coronary computed tomography which described an image compatible with a patent foramen ovale and normal coronary arteries. During the follow-up a cardio magnetic resonance (CMR) is performed which showed a severely dilated right ventricle with diskinetic areas, no volume changes since last CMR (5 years ago) and preserved ejection fraction. A small interatrial communication located infero-posteriorly in the septum drawed our attention. Estimated QP/QS was 1.4. After this finding, we reviewed the CT made 4 years ago, where a flow from the left atrium to the right atrium could be seen. We decided to ask for both a transthoracic echocardiography (TTE) and a transesophageal echocardiography (TEE). TTE showed normal left ventricle, a dilated right ventricle with preserved function, no valvulopathies and normal pulmonary pressure. Shunt test with agitated saline was slightly positive after Valsalva maneuver, and QP/QS was again 1.4. TTE showed a small interatrial communication measuring 1.9x0.8cm, next to inferior vena cava`s drainage. Since right ventricle dilation could be due both to the atrial septal defect (ASD) and to the dysplasia, the case was discussed in the heart team, and as the defect was small, QP/QS was 1.4 and pulmonary pressure was normal we adopted a conservative approach. Inferior sinus venosus defects are one of the least common atrial septal defects. They are located in the atrial septum immediately above the orifice of the inferior vena cava and are often associated with partial anomalous connection of the right pulmonary veins. This location makes it difficult to see by means of a common TTE or TEE, and usually as in our case multimodal approach can be very helpful. Usually patients with this kind of atrial septal defect (ASD), signs of significant shunt (right ventricular volume overload, QP/QS≥1.5) and systolic PA pressure less than 50% of systemic pressure (with pulmonary vascular resistance less than one third of the systemic vascular resistance) are suggested for surgery. In this case the possibility of two pathologies overlapping makes it challenging for diagnosis and treatment. Abstract P718 Figure. Multimodal imaging for diagnosis.

Angioplasty with stenting of anomalous connections of the coronary arteries: A potential alternative to surgery. Results of the prospective ANOCOR stenting registry

Anomalous connections of the coronary arteries (ANOCOR) with an interarterial course raise therapeutic problems. Current guidelines recommend a surgical repair regardless of age for right ANOCOR with ischemic symptoms or documented myocardial ischemia. The lack of controlled studies explain some therapeutic reluctances. A percutaneous approach may provide an interesting alternative in a selected adult population. To assess the feasibility and safety of interarterial segment stenting in right ANOCOR. Stenting was proposed according to predefined criteria (age > 20 years, ischemic symptoms or documented myocardial ischemia, slit-like ostium) for patients referred to an expert group. All patients underwent selective coronary angiography and coronary computed tomography (CT). Evaluation by intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was recommended. A systematic coronary CT and functional test were proposed at 6-12 months. Clinical follow-up was scheduled at 6, 12 and 60 months. Sixteen patients (mean age 52 years) were prospectively included between 2014 and 2019. Fourteen patients were symptomatic and two patients were asymptomatic with documented myocardial ischemia. Stenting was successful in all procedures with mean stent diameter of 3.4 mm, mean stent length of 25 mm, mean fluoroscopy time of 19 min, > 80% of IVUS or OCT guidance, and mean troponin at 24 hours of 0.51 μg/L. No in-hospital complication occurred. No extrinsic stent compression was observed on coronary CT follow-up. Clinical follow-up at 12 months was uneventful in all but three patients: one patient with persistent angina reported to vasospastic angina and two patients with intrastent restenosis treated by balloon angioplasty. Interarterial segment stenting appears feasible and safe. More important population and longer follow-up are needed to include this approach in a future management algorithm for patients with ANOCOR.