Anomalous Coronary Artery Research Articles

Presence of an anomalous coronary artery: A potential risk factor for device-related late coronary ischemic syndromes following transcatheter aortic valve implantation?

Presence of an anomalous coronary artery: A potential risk factor for device-related late coronary ischemic syndromes following transcatheter aortic valve implantation?

Anomalous Origin of Left Circumflex Coronary Artery From Right Pulmonary Artery: An Unusual Cause of Sudden Cardiac Arrest

Anomalous origin of the left circumflex coronary artery from the right pulmonary artery is an extremely rare coronary anomaly out of the group of anomalous coronary arteries arising from the pulmonary artery. We present the case of a 27-year-old male, in whom the diagnosis of an anomalous left circumflex coronary artery from the pulmonary artery was made after sudden cardiac arrest. The diagnosis was confirmed by multimodal imaging and the patient underwent successful surgical correction. Abnormal origins of a coronary artery may become symptomatic later in life and may occur as an isolated cardiac malformation. Due to a potentially unfavorable clinical course, surgical correction should be considered as soon as a diagnosis is made.

Clinical characteristics of anomalous aortic origin of a coronary artery in children

Objective: To analyze the clinical characteristics, diagnosis and treatment of anomalous aortic origin of a coronary artery (AAOCA) in children. Methods: There were 17 children diagnosed with AAOCA from January 2013 to January 2022 in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine.Their clinical manifestations, laboratory and imaging data, treatment and prognosis were retrospectively analyzed. Results: These 17 children included 14 males and 3 females, with the age of (8.7±3.5) years. There were 4 anomalous left coronary artery (ALCA) and 13 anomalous right coronary artery (ARCA). Seven children presented with chest pain or chest pain after exercise, three patients presented with cardiac syncope, one complained chest tightness and weakness, and the other six patients had no specific symptoms. Cardiac syncope and chest tightness occurred in patients with ALCA. Fourteen children had the dangerous anatomical basis of myocardial ischemia caused by coronary artery compression or stenosis on imaging. Seven children had coronary artery repair, of whom two were ALCA and five were ARCA. One patient had received heart transplantation because of heart failure. The incidence of adverse cardiovascular events and poor prognosis in ALCA group was higher than that in ARCA group (4/4 vs. 0/13, P<0.05). They were followed up in the outpatient department regularly for 6 (6, 12) months; except for the one who lost visit, the rest of the patients had a good prognosis. Conclusions: Cardiogenic syncope or cardiac insufficiency usually occurs in ALCA, and adverse cardiovascular events and poor prognosis are more common in ALCA than in ARCA. Early surgical treatment should be considered for children with ALCA and ARCA accompanied by myocardial ischemia.

Evolution of surgical repair of intraseptal anomalous left coronary artery with myocardial ischaemia.

Anomalous aortic origin of the left coronary artery with intraseptal course is a rare coronary anomaly associated with an increased risk of myocardial ischaemia. The role and techniques for surgical intervention are evolving, with numerous novel surgical techniques for this challenging anatomy reported in the last 5 years. We report our single-centre experience with surgical repair of intraseptal anomalous left coronary artery in the paediatric population, including clinical presentation, evaluation, and short- to mid-term outcomes. All patients with coronary anomalies presenting to our institution undergo standardised clinical evaluation. Five patients aged 4 to 17 years underwent surgical intervention for intraseptal anomalous aortic origin of the left coronary artery between 2012 and 2022. Surgical techniques included coronary artery bypass grafting (n = 1), direct reimplantation with limited supra-arterial myotomy via right ventriculotomy (n = 1), and transconal supra-arterial myotomy with right ventricular outflow tract patch reconstruction (n = 3). All patients had evidence of haemodynamically significant coronary compression, and three had evidence of inducible myocardial ischaemia pre-operatively. There were no deaths or major complications. Median follow-up was 6.1 months (range 3.1-33.4 months). Patients who underwent supra-arterial myotomy (with or without reimplantation) had improved coronary flow and perfusion based on stress imaging and catheterisation data. Surgical approaches to intraseptal anomalous left coronary artery with evidence of myocardial ischaemia continue to evolve, with new techniques demonstrating promising improvement in coronary perfusion. Further studies are warranted to determine long-term outcomes and refine indications for repair.

Percutaneous coronary intervention of anomalous right coronary arteries arising from the left sinus of Valsalva: a single-centre experience from Northern India

An anomalous right coronary artery (ARCA) arising from the left sinus of Valsalva is an uncommon congenital anomaly. The unusual location, take-off and intramural courses of ARCA pose a considerable technical challenge during percutaneous coronary intervention (PCI). We sought to report our experience of PCI of ARCA in 35 cases of atherosclerotic occlusion. The PCI database of 35 cases of ARCA was retrospectively analysed. The details about demography, clinical presentation, PCI procedure and clinical follow-up were noted. The mean age was 56.7±13.5 years. The clinical presentation included stable angina in 45.7%, unstable angina in 20% and acute myocardial infarction in 34.3% of patients. Vascular access was transradial in 37.1% of cases, transfemoral in 60% of cases, and transbrachial in 1 case (2.9%). Judkins left and Amplatz left were commonly used guide catheters. Two patients with balloon-uncrossable, calcified lesions required rotablation-assisted PCI. Intravascular imaging was performed in 12 patients (34.3%). Optical coherence tomography demonstrated a proximal intramural course in 3 patients, and a slit-like orifice in 4 patients. The mean radiation dose and fluoroscopy time were 877±687.3 mGy and 18.8±11.6 minutes, respectively. Twenty-eight (80%) patients had an asymptomatic median follow-up of 49 (interquartile range: 29.0-97.5) months. We performed successful PCI in a cohort of 35 patients with ARCA, with favourable long-term clinical outcomes. The selection of an appropriate guide catheter and technical skills were important factors in achieving favourable results.

Procedural Success and Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention of Anomalous Coronary Arteries.

Procedural Success and Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention of Anomalous Coronary Arteries.

Dorosła z Tetralogią Fallota, anomalią odejścia tętnicy wieńcowej, niescaleniem lewej komory, ubytkiem w przegrodzie międzyprzedsionkowej i nawracającym zwężeniem w drodze odpływu prawej komory

Advances in therapeutical possibilities for patients with complex congenital heart defects are unquestionable. Nonetheless, it is still probable to encounter unique challenges. The study presents a case of a symptomatic 25-year-old female patient with uncorrected Tetralogy of Fallot who has never been qualified for surgery due to an unusual constellation of cardiac congenital comorbidities: anomalous coronary artery origin and non-compaction of the left ventricle.

Complex Repair of Anomalous Left Coronary Artery From the Pulmonary Artery in a 55-Year-Old Patient.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a congenital malformation that classically presents within the first year of life. Few patients survive into adulthood, and initial presentation after the fourth decade of life is rare. We describe a 55-year-old woman who presented after cardiac arrest. She initially refused surgery and underwent automated implantable cardioverter defibrillator placement, followed later by surgical repair involving reimplantation of the left coronary artery to the aorta and pulmonary artery reconstruction using interposition grafts. We report this late presentation of ALCAPA and successful surgical management.

Outcome of surgical repair of anomalous left coronary artery from the pulmonary artery in a single-center experience

BackgroundThis study aims to review the midterm results of surgical repair of anomalous left coronary artery from the pulmonary artery (ALCAPA) in our center and assess the postoperative cardiac function recovery and misdiagnosis. MethodPatients who underwent repair of ALCAPA between January 2005 and January 2022 at our hospital were retrospectively reviewed. ResultsA total of 136 patients underwent repair of ALCAPA, among which 49.3% were misdiagnosed before referral to our hospital. On multivariable logistic regression analysis, patients with low left ventricular ejection fraction (LVEF) (odds ratio = 0.975, p = 0.018) were at increased risk for misdiagnosis. The median age at surgery was 0.83 years (range, 0.08 to 56 years), and the median LVEF was 52% (range, 5% to 86%). The mortality rate was 6.6% (n = 9), and four patients underwent reintervention. The median postoperative recovery time of left ventricular function (LVF) was 10 days (1 to 692 days). Competing risk analysis revealed that a low preoperative LVEF (hazard ratio = 1.067, p < 0.001) and age younger than 1 year (hazard ratio = 0.522, p = 0.007) were risk factors for a longer postoperative recovery time of LVF. During the follow-up period, 91.9% (113/123) of the patients had no aggravation of mitral regurgitation. ConclusionThe perioperative and intermediate outcomes after ALCAPA repair were favorable, but preoperative misdiagnosis deserved attention, especially in patients with low LVEF. LVF normalized in most patients, but patients younger than 1 year and with low LVEF required longer recovery times.

Once in a Blue Moon: Iatrogenic Coronary Dissection in Anomalous Coronary Artery

Coronary anomalies present as a rare phenomenon. One of the most observed coronary anomalies is the single coronary artery (SCA) originating from one coronary ostium and dividing into the coronary arteries in various configurations1Angelini P. Coronary artery anomalies: an entity in search of an identity.Circulation. 2007; 115: 1296-1305Crossref PubMed Scopus (532) Google Scholar, classified by Lipton’s Classification.2Lipton M.J. Barry W.H. Obrez I. Silverman J.F. Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.Radiology. 1979; 130: 39-47Crossref PubMed Scopus (414) Google Scholar A 38-year-old male patient was admitted to a community hospital with typical signs of non-ST-elevation myocardial infarction (NSTEMI) but without any known comorbidities. Urgent coronary angiography revealed a rare anomaly (incidence of 0.008%3Yamanaka O. Hobbs R.E. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.Cathet Cardiovasc Diagn. 1990; 21: 28-40Crossref PubMed Google Scholar,4Mohanty A. Chandra S. A rare case of 'superdominant' single coronary artery.Indian Heart J. 2015; 67: 389-391Abstract Full Text Full Text PDF Google Scholar) of an SCA with the left coronary system originating from the right coronary periphery, posterior to the great vessels (Lipton’s Classification R-IP, table 1) and occlusion of the circumflex artery (CX) (figure 1a-b, video 1). A culprit-lesion percutaneous coronary intervention was attempted. However, despite the use of various flexible guidewires and angled microcatheters (90°) CX passage through the left main artery equivalent (LMA) was not achieved (video 2) and resulted in ST elevation. A prompt control demonstrated a dissection of the LMA (figure 1c, video 3). Further interventional approaches were waived and the patient was transferred for surgical revascularization.Table 1Lipton’s Single Coronary Artery Classification2Lipton M.J. Barry W.H. Obrez I. Silverman J.F. Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance.Radiology. 1979; 130: 39-47Crossref PubMed Scopus (414) Google ScholarCodeDescriptionOstial LocationRRight Sinus of ValsalvaLLeft Sinus of ValsalvaAnatomical DistributionIThe solitary domain vessel follows the course of either a normal right or left coronary arteryIIOne coronary artery arises from the proximal part of the normally located other coronary arteryIIILAD and CX arise separately from a common trunk originating from the right sinus of ValsalvaCourse of the Transverse TrunkAAnterior to the great vesselsBBetween the aorta and the pulmonary arteriesPPosterior to the great vesselsSSeptal Type: A part of the route passes through the interventricular septumCCombined Type: Combination of diverse routes Open table in a new tab Intraoperatively, coronary dissection could be confirmed, whereas the left anterior descending artery (LAD) and CX were identified in the typical locations. Coronary revascularization was performed by anastomosis of the left internal mammary artery to the LAD, and a saphenous vein graft to the CX in perfusion-assisted beating heart technique. The postoperative course remained uneventful and the patient was discharged on the 10th postoperative day. The main issue in SCA persists in the dependency on one system with fatal results in proximal occlusion. Since the overall incidence of coronary anomalies is very low3Yamanaka O. Hobbs R.E. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography.Cathet Cardiovasc Diagn. 1990; 21: 28-40Crossref PubMed Google Scholar, the treatment strategy for acute coronary syndromes in patients with anomalous coronary anatomy remains questionable. In particular, an interventional approach in complex coronary anatomy can result in coronary injury. Since in cases of myocardial infarction time matters most, a deep – even inter-hospital – heart team approach is crucial to maintain in-time life-saving treatments. •Lipton’s Classification R-IP is the rarest form of single coronary artery configuration with the left coronary system originating from the right coronary periphery.•Percutaneous coronary intervention of the left coronary system may be very challenging in Lipton’s Classification R-IP•Surgical revascularization is a reasonable strategy in particular when the coronary periphery location is in typical location.•A deep heart team approach is crucial to maintain in-time life-saving treatments in such critical and complex cases. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1ZWIwZTk5NTRiZWEzMDA2MGVlNzI5MmM4OTZjNDlmYyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc2MjA3NTg4fQ.My1bJvayG27S7R8PKVtQsWVd9XLKhwldpsEWqzuMHIzYxOz_VIFRiJulyjzbngC4CyNUqZMU_qmU-_r_3QPgVbNU2xkwNmcDVsxgXDGD3oSMx3rmyXQK-bNXjlY-qh_YzCrTQ4UEB8jH1qiVcNVpHyrGc-MtRjc7v89p3xEBD1aa_Ns-xk1OOfXUrdGlF9O7EQX7iWrHtaVkLbdCUhgxc55eQP4YI97gKqxSTzFKe4nOdxPc5K41oBsMkajdNYt83O5oDph59QzDCmbWJJDlinjzvGQqRFcavZjX7emVYeuqr5DOGxgmXTA36j331owW-wzHpdKn7wy_SAu2l1u30g Download .mp4 (3.49 MB) Help with .mp4 files eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIzYjhkMDgxYzg2OTRiYTM0MDZmYTgyZDcyYzcxMmI1NyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc2MjA3NTg4fQ.gH37xsv4GXLcsKMdb-SAuac7Xh_CpCm5C0UOpTzC6x5WB68zYxcjtSgpUhdMHve6TUbPHbeu4gyaKxxZOZFAyXhaMk3R4CzuIFQGSdNyQ3UbqN2MXekQOyGM0i6FNEiLMnWIlxCoQlwOvXWyQ1sI5cKCz5qIkr0f6r_5o2C3gv15nrn3mBIX3vPynprGA_1gHGfLtCQXAvMvVUwYfg-Ba-GOjt1NTSJ0ccCjlQefWR_6jSDTk7NX3BfZ5jU-ybtSzeAxEfALNpfSP2YHm960AaPVaXDNtI0CYb5bkGWLepuD3vzkGAahQrf2K23VUEfho5FELp_CpUVjx4EUMLZ3gA Download .mp4 (1.48 MB) Help with .mp4 files eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI2MTc2OTE5MTY2ZDM1OTQ1NTUzYTQ3MzcwOTc1OWJlNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc2MjA3NTg4fQ.G5pvhhPUt-Kl_kxjdKfL-lOu-rH4hRhKzFlVwwANSrmNUjBoRc_thtwNvFupLmPpm1meakrWBTvBZ-JrBLOAlq6fW3AXl46Qy5drW5RxsehHs52zYd8GMPUQ9Trimxz6LG5NH50cVzlCWKi_iaZKUGpRueErVe1WFrp0YqXxkauvv-qmuoIW2pTQS1IpP-6E3u_z8OpKdj53TlaNfpGQJq3z28Uqw5FsY44sS9OP0k_A6uhflBqSRFLKU22pDTS3TPOUSqoxJAATd7yxU-H9QckIiu6lEHsAS2AKowXlAZiXHJnAcRaOBWAFkXx7eJ-MkLy7Eqms1glQNP6hxmoK4Q Download .mp4 (0.95 MB) Help with .mp4 files

Anomalous left coronary artery from the pulmonary artery syndrome: When everything falls into place

Anomalous left coronary artery from the pulmonary artery syndrome: When everything falls into place

Effectiveness and Safety of Mitral Valve Plasty in Patients with an Anomalous Origin of the Coronary Artery from the Pulmonary Artery

The study aimed to determine the effectiveness and safety of anomalous coronary artery from pulmonary artery (ACAPA) patients with moderate or severe mitral valve regurgitation (MVR) receiving mitral valve plasty (MVP) concurrently. Consecutive ACAPA patients undergoing surgery between 2015 and 2021 were retrospectively included. Patients were divided into three groups: moderate MVR without MVP (non-MVP (moderate) N = 14), moderate MVR with MVP (MVP (moderate) N = 13), and severe MVR with MVP (MVP (severe) N = 13). The primary safety endpoint was in-hospital surgery-related complications. The primary effectiveness outcome was left ventricular ejection function (LVEF) and left ventricular end-diastolic diameter (LVEDD) z-score at 2- and 24-month follow-ups. Multivariable linear regression models were used to obtain the β coefficient. The median age of the included patients was 7.5 years (IQR 1.4-26.5). The in-hospital surgery-related complication rates were 7.1%, 15.4%, and 7.7% in non-MVP (moderate), MVP (moderate), and MVP (severe) groups, separately. At the 2-month follow-up, the non-MVP (moderate) group had a better LVEF and LVEDD z-score compared with the MVP (moderate) group (LVEF β = 9.22, 95%CI 1.09 to 17.35; LVEDD z-score β = -2.49, 95%CI -4.53 to -0.45). At the 24-month follow-up, the LVEF of all patients and the LVEDD z-score of 90% of patients in the three groups returned to normal. For ACAPA patients with moderate MVR, MVP was not necessary, especially for pediatric patients (age < 3 years) and patients with secondary MVR. Further studies for ACAPA patients with severe MVR are still needed.

Anomalous Coronary Arteries: A State-of-the-Art Approach.

Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.

Intramural course of an anomalous left coronary artery is not always associated with a slit-like ostium.

Anomalous aortic origin of the left coronary artery from an incorrect aortic sinus has been reported as the second most common causes of sudden cardiac arrest in young athletes. Intramural course of the proximal left coronary artery is considered a high-risk morphology. It is associated with a slit-like ostium and elliptical shape of the proximal artery. In this case, all pre-operative cardiac images demonstrated a round ostium and round luminal shape of the left coronary artery, which suggested no evidence of intramural course. On intraoperative inspection, although the ostium and proximal left coronary artery appeared round, the patient had a long intramural course of the left coronary artery which our surgeons performed a successful unroofing procedure. The post-operative images showed a patent new ostium from the correct aortic sinus. These findings are very unusual and proved that we should not exclude intramural course even in the absence of a slit-like ostium and elliptical shape of the proximal left coronary artery.

Transcatheter aortic valve implantation in patients with anomalous coronary artery.

The aim of this review was to analyze literature and provide systematic algorithm to guide decision making during TAVI procedure. Transcatheter aortic valve implantation (TAVI) is growing in popularity and expanding to younger patients with lower risk profiles. Currently, there is no concise guideline on the management strategy during TAVI in patients with anomalous coronary artery (ACA) anatomy undergoing this procedure. A systematic search was conducted for relevant case reports of TAVI in patients who had confirmed ACA anatomy. Twenty-fourcase reports, that met the criteria for this review, were identified and included in the final study size. TAVI was successful in 23 out of 24 cases. Half of the cases (12) described performing balloon aortic valvuloplasty (BAV) before TAVI. The majority (15) reported using angiogram Postimplantation. Only one-third of cases (8) reported performing coronary protection (with either wire, wire and stent or wire and balloon). Two-third of case reports (16/24, 67%) mentioned using Edwards SAPIEN balloon expandable transcatheter heart valves (THV). Preprocedural diagnostic imaging tests play important role in determining the ACA anatomy and its relation to the aortic valve. BAV with simultaneous coronary arteries angiography or aortography should be performed before implantation of THV, as it could potentially predict whether the ACA would be compressed. Using at least a coronary wire for ACA protection is recommended in case there is high risk of ACA obstruction. Management strategy should be individualized when performing TAVI in patients with ACA.

Detection of anomalous aortic origin of a coronary artery (AAOCA) by echocardiogram: When does computed tomographic angiography add value?

Background and objectiveThere is limited literature comparing TTE and CCTA in children with suspected AAOCA. To determine the distribution of various coronary anomalies comparing TTE and CCTA data, and define the added value advanced imaging brings in clinical decision-making. Materials and methodsRetrospective review of data was obtained in patients aged 0–18 years who underwent TTE and CCTA for suspected AAOCA. Patient demographics, CCTA and TTE findings, and interventions performed were recorded. Results100 consecutive patients were included (60% male), mean age 11 years (7 days-18 years old). In 93 patients, CCTA detected 94 anomalous coronaries. Definitive coronary abnormality was reported on TTE in 77 patients; 76 of which were confirmed by CCTA, 1 patient was found to have a normal variant. Suspected anomalous origin was reported in 16 patients on TTE, 13 of which were abnormal on CCTA. The coronary origin was not seen on TTE in 6 patients; of these, 3 had AAOCA on CCTA and 3 had hypoplastic RCA with left dominant system. Only 1 patient who had a normal TTE was found to have AAOCA on CCTA.CCTA was better than TTE in defining ostial characteristics and the course of the anomalous coronary artery, and detecting myocardial bridge. ConclusionsCCTA adds value in diagnosing AAOCA when the coronary origins are not well assessed or suspected anomalous origin is suggested on TTE. In addition, when a confident definitive diagnosis of AAOCA is reported on TTE, CCTA demonstrates better performance in determining additional features of AAOCA.

Unroofing of an anomalous right coronary artery originating from the left coronary sinus

Coronary abnormalities, including the anomalous aortic origin of a coronary artery, coronary fistula and myocardial bridge, are among the most common congenital cardiovascular anomalies. A left coronary artery arising from the right cusp is less common than the right coronary artery arising from the left cusp but is more often found in autopsy series of sudden cardiac deaths. A slit-like/fish-mouth-shaped orifice, acute angle take-off, intramural course, interarterial course and hypoplasia of the proximal coronary artery have all been proposed as reasons for symptoms, ischaemia and sudden cardiac death. Surgical intervention is recommended for those patients with signs or symptoms of myocardial ischaemia. Intervention in asymptomatic patients with an interarterial/intramural left coronary artery from the right sinus of Valsalva is recommended due to the higher calculated risk of sudden cardiac death. In asymptomatic patients with an intramural right coronary artery from the left sinus of Valsalva, provocative testing is recommended. The slit-like orifice is more commonly seen in an anomalous right coronary artery arising from the left sinus, and we believe it is the major factor responsible for myocardial ischaemia. Our unroofing technique focuses on: (i) transecting the endothelial tissue flap to create a neo-ostium; (ii) limiting the flap resection to the intramural portion to avoid extra-aortic incision; and (iii) marsupialization of a neo-ostium with interrupted sutures to reapproximate the endothelium and prevent aortic dissection.

Surgical Reconstruction of the Anomalous Left Coronary Artery From the Pulmonary Artery.

The anomalous left coronary artery from the pulmonary artery is a rare congenital disease. Early surgical reconstruction is mandatory to prevent adverse cardiac events. Direct coronary button transfer, vein graft interposition, ligation, and coronary artery bypass construction are the most commonly used techniques. This case report presents a modified technique of Dacron graft interposition and reimplantation anomalous left coronary artery from the pulmonary artery on the ascending aorta.

Successful Use of Angiotensin Receptor–Neprilysin Inhibitor along with Intravenous Inotropes, in a Postcardiac Surgery Child with an Anomalous Left Coronary Artery from the Pulmonary Artery Repair

Abstract Treating heart failure (HF) in postoperative congenital cardiac repair in children with an anomalous left coronary artery from the pulmonary artery (ALCAPA) is a daunting task. Regular anti-failure measures with angiotensin-converting enzyme (ACE) inhibitors may become inadequate or resistant in certain situations. Angiotensin receptor–neprilysin inhibitor (ARNI) in place of ACE inhibitors can be an alternative to help these postcardiac surgical children convalesce better. Sacubitril/valsartan is an ARNI-approved treatment for HF in adults, and in pediatric HF patients, it is showing promising benefits. However, in postcardiac surgical children with HF, its effects are not known. We used ARNI successfully in one of our postcardiac surgical infants with ALCAPA repair in HF, and we describe this case here.

Prevalence of Coronary Artery Anomalies and Associated Complications during Catheter-guided Angiography: A Retrospective Study

Introduction: Coronary Artery Anomalies (CAA) refer to very uncommon and unusual morphological features of the epicardial coronary artery that account for 1/5th of deaths in athletes. Patients with CAA are also prone to developing significant Coronary Artery Disease (CAD). Identifying such arteries during catheter-guided angiography is very challenging and is associated with many devastating complications, such as arrhythmia, heart failure, Contrast-Induced Nephropathy (CIN), bleeding, cardio-embolic events, and mechanical injury to the coronary artery, among others. Aim: The aim of this study is to describe the prevalence of various types of coronary anomalies and the complications that arise during catheter-guided angiography. Materials and Methods: A retrospective study was conducted between February 2022 and October 2022, enrolling a total of 2849 patients who underwent angiography for angina or angina equivalents at the catheterisation laboratory, VIMSAR, Burla, Odisha, India. Angiographic records and videos of patients were noted. Coronary anomalies were detected based on quantitative and qualitative criteria provided by the American Heart Association in 2007. The anomalous coronary arteries were classified into three groups: Group A- anomalies of origin and course, Group B- anomalies of intrinsic coronary arterial anatomy, and Group C- anomalies of coronary termination. Data regarding baseline characteristics and procedurerelated complications were collected, compiled, and tabulated to determine the prevalence of different types of coronary anomalies and the arising complications during catheterguided angiography. Results: Among the 2849 enrolled patients, CAA was identified in 64 (2.24%) patients. Of these, CAA with abnormal origin and course (Group A), abnormal termination (Group B), and intrinsic coronary arterial anatomy (Group C) were detected in 36 (1.26%), 4 (0.14%), and 24 (0.84%) patients, respectively. Out of the 64 cases, a total of 13 (20.3%) patients developed different types of complications, including mechanical 2 (3.125%), embolic 1 (1.56%), and arrhythmic 3 (4.68%) complications, bleeding 2 (3.12%), angiographic 3 (4.68%), and left ventricular failure 2 (3.12%), among others. In Group A, complications were more commonly observed in 10 (15.6%) of the cases. Conclusion: CAA with an abnormal origin and course is the most common type of coronary anomaly. Engaging such an artery and detecting its abnormal course are more commonly associated with life-threatening complications. The use of appropriate maneuvers, types and sizes of catheters, and CIN views can help avoid disastrous complications.