Anomalous Origin Of Coronary Artery Research Articles

Use of advanced 3D modelling and printing for congenital heart disease at a large surgical center

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Rachel Cooper Innovative Technologies Fund Background 3D cardiac models, digital and physical, are being used for pre-procedural planning for management of congenital heart disease. Purpose We describe the application of 3D cardiac modelling with details regarding which indications were typically useful to 3D print at our high volume congenital cardiac surgical center. Methods We reviewed patients with congenital heart disease for whom 3D models were created at our institution from January 2018 to December 2022. The diagnosis and indications for the 3D model were collected. Indications for model were separated into 1) complex intracardiac anatomy 2) ventricular assist device/transplant planning 3) anomalous coronary artery origins and 4) other. The mode of 3D modelling was identified as digital model or 3D print. Results A total of 61 models were created over the 5 year period. Indications for advanced modelling were: 30 with complex intracardiac anatomy, 17 ventricular assist device/transplant planning, 9 with anomalous coronary artery and 6 with other indications. Patients included in the "other" category were those with extracardiac congenital anomalies. A total of 25 3D printed cardiac models were created. These included 12/30 of the complex intracardiac anatomy patients, 12/17 of the ventricular assist device/transplant planning patients and 1/6 of the patients with complex extracardiac anatomy (Figure 1). An example of a 3D printed cardiac model used for presurgical planning for a patient with anomalous right pulmonary venous drainage to the inferior vena cava is demonstrated in Figure 2. Right atrium (RA), left atrium (LA), inferior vena cava (IVC), right pulmonary artery (RPA), aorta (Ao). Conclusion 3D printed cardiac models were more commonly utilized at our center than digital models for ventricular assist device and transplant planning than for any other indication including complex intracardiac anatomy.

CT-derived anatomic high-risk features in patients with anomalous aortic origin of a right coronary artery correlate with an impaired FFR assessed by computational fluid dynamics

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FNSNF - Schweizerischer Nationalfonds zur Förderung der wissenschaftlichen Forschung. Introduction Anomalous aortic origin of a right coronary artery (AAORCA) are a rare subtype of coronary artery anomalies, which occur with a prevalence of 0.23% in the general population. Especially, AAORCA with an interarterial course between the aorta and the pulmonary artery confer high risk of myocardial ischaemia. The interarterial course is however only a surrogate marker for other anatomic high-risk-features (HRF) such as intramural course (IMC), slit-like ostium (SLO), proximal narrowing (PN), acute take-off angle (ATOA) and proximal elliptic vessel shape (PEV). Computed tomography-derived fractional flow reserve (CT-FFR) is a novel tool, which allows noninvasive assessment of haemodynamics, so far assessed in patients with atherosclerotic stenosis. Our aim was to investigate the correlation of HRF in AAORCA with CT-FFR of the anomalous vessel. Purpose In patients with newly detected AAORCA, it is important to evaluate the underlying mechanisms of hemodynamic relevance and currently it is unknown how- and which anatomical high-risk features correlate with ischemia in noninvasively assessed CT-FFR. Methods All patients with AAORCA, who underwent CT imaging between 12/2008 and 9/2022, were retrospectively enrolled. HRF were evaluated from CT images as following: IMC (i.e. length ≥5mm), SLO (i.e. stenosis grade of the proximal lumen compared to the distal lumen ≥50%), PN (i.e. stenosis grade of the proximal lumen to the first round lumen ≥50%), ATOA (i.e. <45°) and PEV (i.e. length/width ratio >1.3). Patients were divided into group 1 (≥4HRF) and group 2 (<4HRF). FFR was calculated using computational fluid dynamics (CT-FFR) using Siemens CT Research cFFR and the cut-off < 0.8 was considered hemodynamically relevant and correlations were performed. Results In total 47 patients, 56.7±14.2years, thereof 34 (72%) male were included in the final analysis. Mean CT-FFR for the anomalous vessel in the whole cohort was 0.93±0.05. IML, ATOA and PEV were present in all patients, whereas SLO was in 22 (46%) and PN in 11 (23%) present. 25 (53%) patients showed ≥4 HRF. In group 1 (≥4HRF), mean CT-FFR within the anomalous vessel was significantly lower compared to group 2 (<4HRF) with 0.91 versus 0.95 (p = 0.002). Three patients (6%) showed a CT-FFR<0.8 and were all within group 1. CT-FFR correlated significantly with SLO (r=-0.348, p = 0.017), but not with other HRF. Conclusion Patients with AAORCA and ≥4HRF showed lower CT-FFR values of the anomalous vessel compared to those with less high-risk features (i.e. <4HRF). A minority of patients showed abnormal CT-FFR, all within the group with ≥4HRF. From all HRF, only SLO correlated with CT-FFR. Future studies need to assess how the combination of anatomical high-risk features and CT-FFR can be used for decision-making towards revascularization in AAORCA patients.

Comparison of CT-FFR to invasively measured FFR adenosine and FFR dobutamine in patients with an anomalous aortic origin of a right coronary artery

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FNSNF - Schweizerischer Nationalfonds zur Förderung der wissenschaftlichen Forschung. Introduction Anomalous aortic origin of a right coronary artery (AAORCA) is a rare congenital anomaly. Malignant AAORCA with an interarterial course between the great arteries inherit an anticipated higher risk for myocardial ischemia. Anatomical high-risk features are beside the interarterial course the slit-like ostium (SLO), elliptic vessel shape (EVS), proximal narrowing (PN), acute take-off angle (ATOA) and an intramural course (IM) inside the aortic wall. The complex anatomy lead to both a fixed and further dynamic component of anomalous vessel compression. The suggested gold-standard for the assessment of combination (i.e. fixed and dynamic component) is invasively measured fractional flow reserve (FFR) during dobutamine and volume challenge, whereas FFR under adenosine may only cover the fixed components. A possible non-invasive alternative for FFR assessment is novel CT-FFR method, which can calculate FFR from coronary computed tomography angiogram (CCTA) images using computational fluid dynamics (CFD). Purpose CT-FFR may be used as a non-invasive alternative to invasive FFR measurements. Our aim was to compare CT-FFR to invasively measured FFRadenosine and FFRdobutamine in patients with AAORCA. Methods Consecutive patients enrolled in the NARCO trial (i.e. Noninvasive anatomical assessment for ruling out hemodynamically relevant coronary artery anomalies – A comparison of coronary-CT to invasive coronary angiography), with AAORCA undergoing CCTA and invasively measured ischemia assessment were included. All patients underwent CCTA for quantification of anatomical high-risk features and analysis of CT-FFR, invasive coronary angiography using FFR with adenosine (140μg/kg/min) and secondly with dobutamine and volume challenge (40 μg/kg/min + saline: 1.5–3 l+ atropine: 1 mg). Comparison between different methods was performed. Results In total, 29 consecutive patients with an AAORCA with an interarterial course (56 ± 13 years old), 22 (76%) male patients who underwent both CCTA and invasive coronary angiography were included. SLO was present in 18 (62%), PN in 5 (17%), EVS in 29 (100%) and an ATOA in 29 (100%) patients. An IM was present in 28 (97%) with a mean length of 11 ± 4 mm. While there was no difference between CT-FFR and FFRadenosine (p = 0.656), the mean invasive measured FFRdobutamine (0.85 ± 0.11), was significantly lower than FFRadenosine (0.88 ± 0.10, p = 0.002) and trend towards lower values than CT-FFR (0.89 ± 0.06, p = 0.063). Conclusion In patients with AAORCA, CT-FFR shows no difference with FFRadenosine, but they both overestimate FFR compared to FFRdobutamine gold-standard. Hence, there is a need for CCTA derived CFD FFR models, including dynamic components and mimicking FFR under dobutamine stress.

Anomalous Origin of the Left Circumflex Coronary Artery and Potentially Fatal Complication in Aortic Valve Replacement

The most frequent congenital coronary variant is the anomalous origin of the left circumflex coronary artery, from either the right coronary artery or the right sinus of Valsalva (RSV). The prevalence of this anomaly is about 0.08%–0.67%, and it remains asymptomatic. Unless such an anomaly is recognised and cautiously dealt with, it can result in potentially fatal complications in case of aortic valve replacement (AVR).

Anomalous Aortic Origin of the Right Coronary Artery: Invasive Haemodynamic Assessment in Adult Patients With High-Risk Anatomic Features.

Anomalous aortic origin of a right coronary artery (AAORCA) with an interarterial course merits further evaluation; however, robust risk assessment strategies for myocardial ischemia and sudden cardiac death are currently lacking. The aim of this study is to explore the potential role of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and intravascular ultrasound (IVUS) in patients with AAORCA. Consecutive adult patients with AAORCA with an interarterial course were included. Computed tomography angiography, noninvasive ischemia detection, and FFR, iFR, and IVUS were performed at baseline and during adrenaline-induced stress. External compression was evaluated with IVUS. Eight patients (63% female, mean age: 53 ± 9.5 years) were included. Five patients (63%) were symptomatic, and computed tomography angiography revealed high-risk anatomy of the AAORCA in all patients. Only in 1 (12.5%) patient FFR and iFR were positive; however, this was attributed at large to concomitant diffuse atherosclerosis. In 2 of 8 (25%), IVUS revealed external compression; however, the ostial coronary surface area remained unchanged. In all patients, a conservative treatment strategy was pursued. During a mean follow-up of 29.3 months (standard deviation ±2.6 months), symptoms spontaneously disappeared in 4 of 5 (80%) and no adverse cardiac events occurred in any of the patients. Despite the presence of high-risk anatomy in all patients, none had proven ischemia prompting a conservative treatment strategy. No adverse cardiac events occurred during follow-up, and in the majority of patients, symptoms spontaneously disappeared. Therefore, FFR, iFR, and IVUS with pharmacologic stress merit further investigation and might contribute to ischemia-based risk stratification and management strategies in adult patients with AAORCA.

Multimodal assessment of anomalous right coronary artery origin

Multimodal assessment of anomalous right coronary artery origin

Advanced imaging in an adult dog with anomalous origin of the left coronary artery from the pulmonary artery and extensive collateral coronary circulation

A three-year-old, spayed female, Bichon Frise was diagnosed with an anomalous origin of the left coronary artery from the pulmonary artery, a rare congenital coronary artery defect which has only been reported in two other dogs. Echocardiography was initially performed, though the final diagnosis was made with angiography and computed tomography angiography. An extensive network of collateral coronary circulation allowed for communication between the dilated, tortuous right coronary artery, and the anomalous left coronary artery. Though collateral circulation likely prolonged the patient's life, it is suspected that coronary steal phenomenon and chronic myocardial ischemia ultimately led to fatal ventricular arrhythmias. The dog died suddenly at the age of six, three years after initial diagnosis.

Analysis on missed diagnosis or misdiagnosis of anomalous origin of left coronary artery from pulmonary artery by echocardiography from one single medical center

Objectives: To analyze the reasons of missed diagnosis or misdiagnosis on anomalous origin of left coronary artery from pulmonary artery (ALCAPA) by echocardiography. Methods: This is a retrospective study. Patients with ALCAPA who underwent surgical treatment in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from August 2008 to December 2021 were included. According to the results of preoperative echocardiography and surgical diagnosis, the patients were divided into confirmed group or missed diagnosis/misdiagnosis group. The results of preoperative echocardiography were collected, and the specific echocardiographic signs were analyzed. According to the experience of the doctors, the echocardiographic signs were divided into four types, namely clear displayed, vague/doubtful displayed, no display and no notice, and the display rate of each sign was calculated (display rate=number of clearly displayed cases/total number of cases×100%). By referring the surgical data, we analyzed and recorded the pathological anatomy and pathophysiological characteristics of the patients, and the rate of missed diagnosis/misdiagnosis of echocardiography in patients with different characteristics was compared. Results: A total of 21 patients were enrolled, including 11 males, aged 1.8 (0.8, 12.3) years (range 1 month to 47 years). Except for one patient with anomalous origin of left anterior descending artery, the others were all originated from the main left coronary artery (LCA). There were 13 cases of ALCAPA in infant and children, and 8 cases of adult ALCAPA. There were 15 cases in the confirmed group (diagnostic accuracy was 71.4% (15/21)), and 6 cases in the missed diagnosis/misdiagnosis group (three cases were misdiagnosed as primary endocardial fibroelastosis, two cases were misdiagnosed as coronary-pulmonary artery fistula; and one case was missed diagnosis). The working years of the physicians in the confirmed group were longer than those in the missed diagnosis/misdiagnosed group ((12.8±5.6) years vs. (8.3±4.7) years, P=0.045). In infants with ALCAPA, the detection rate of LCA-pulmonary shunt (8/10 vs. 0, P=0.035) and coronary collateral circulation (7/10 vs. 0, P=0.042) in confirmed group was higher than that in missed diagnosis/misdiagnosed group. In adult ALCAPA patients, the detection rate of LCA-pulmonary artery shunt was higher in confirmed group than that in missed diagnosis/misdiagnosed group (4/5 vs. 0, P=0.021). The missed diagnosis/misdiagnosis rate of adult type was higher than that of infant type (3/8 vs. 3/13, P=0.410). The rate of missed diagnosis/misdiagnosis was higher in patients with abnormal origin of branches than that of abnormal origin of main trunk (1/1 vs. 5/21, P=0.028). The rate of missed diagnosis/misdiagnosis in patients with LCA running between the main and pulmonary arteries was higher than that distant from the main pulmonary artery septum (4/7 vs. 2/14, P=0.064). The rate of missed diagnosis/misdiagnosis in patients with severe pulmonary hypertension was higher than that in patients without severe pulmonary hypertension (2/3 vs. 4/18, P=0.184). The reasons with an echocardiography missed diagnosis/misdiagnosis rate of≥50% included that (1) the proximal segment of LCA ran between the main and pulmonary arteries; (2) abnormal opening of LCA at the right posterior part of the pulmonary artery; (3) abnormal origin of LCA branches; (4) complicated with severe pulmonary hypertension. Conclusions: Echocardiography physicians' knowledge of ALCAPA and diagnostic vigilance are critical to the accuracy of diagnosis. Attention should be paid to the pediatric cases with no obvious precipitating factors of left ventricular enlargement, regardless of whether the left ventricular function is normal or not, the origin of coronary artery should be routinely explored.

P134 RECURRENT SCAD IN A PATIENT WITH BICUSPID AORTIC VALVE AND ANOMALOUS CORONARY ORIGIN

Abstract Spontaneous coronary artery dissection (SCAD) is recently emerging as an increasingly frequent cause of myocardial infarction and among the main triggering factors we found hypertension, pregnancy, fibromuscular dysplasia and connective tissue diseases (e.g. Marfan syndrome). Recent studies also suggest that even bicuspid aortic valve may be a predisposing condition for the development of spontaneous coronary artery dissection. We report the case of a 45–year–old Caucasian man with no cardiovascular risk factors; his clinical history begins in August 2019, when he was hospitalized for acute coronary syndrome (NSTEMI). Echocardiography showed preserved left ventricular ejection fraction, bicuspid aortic valve (fusion of right and left cusps) with mild to moderate regurgitation without stenosis and mild dilatation of the aortic bulb (38 mm). The coronary angiography showed no significant stenoses and an anomalous origin of the right coronary artery from the common trunk. The patient was discharged two days later with a diagnosis of MINOCA and an indication to perform a coronary CT scan, which confirmed the anomalous origin of the right coronary artery with a retro–aortic course, and a cardiac MRI, which showed myocardial edema of the infero–lateral wall, mainly with sub–endocardial distribution and LGE in the same sites, compatible with ischemic damage. In September 2022 there was a new hospitalization for inferior–posterior–lateral STEMI with coronarographic finding of a large marginal branch collateral stenosis, with recovery of distal caliber. The angiographic pattern was consistent with type II SCAD (no intracoronary imaging has been performed because of vascular tortuosity and lesion distality). A retrospective comparative analysis of the 2019 angiography allowed to find a distal occlusion of the same branch, now healed, also compatible with SCAD. The patient was discharged on single antiplatelet therapy after one week of DAPT with acetylsalicylic acid and clopidogrel and indication to perform a genetic test for connective tissue diseases. The case described prompts the cardiologists to suspect an uncommon etiology (connective tissue disease, bicuspid aortic valve) in case of SCAD detection, especially if associated with anomalous origin of the coronary arteries.

Anomalous aortic origin of right coronary artery from left coronary cusp: a management conundrum: a case report

BackgroundCoronary artery anomalies are characterized by an abnormality in the course or origin of three main coronary arteries. There needs to be more scientific evidence to promptly treat coronary artery anomalies with poorly understood prognostic implications, especially anomalous aortic origin of the right coronary artery from the left coronary cusp.Case presentationA 58-year-old Caucasian female presented multiple times over 6 months with atypical chest discomfort and palpitations. The treadmill exercise test demonstrated exercise-induced non-sustained ventricular tachycardia. A coronary angiogram revealed no obstructive coronary artery disease and an anomalous aortic origin of the right coronary artery from the left coronary cusp with an interarterial course. She was managed conservatively with medications, despite persistent recurrent symptoms.ConclusionIt is essential to identify subtle symptoms and insidious onset of anomalous aortic origin of the right coronary artery symptoms as seen in our patient, which can contribute to significant morbidity. There are discrepancies in existing guidelines between different cardiovascular societies in managing selected subgroups of patients with anomalous aortic origin of the right coronary artery who do not have high-risk features, but continue to remain symptomatic.

Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course

Anomalous aortic origin of the left coronary artery (AAOLCA) confers a rare, but significant, risk of sudden cardiac death in children. Surgery is recommended for interarterial AAOLCA, and other subtypes considered benign. We aimed to determine the clinical characteristics and outcomes of 3 AAOLCA subtypes. All patients with AAOLCA <21 years old were prospectively enrolled (December 2012-November 2020), including group 1: AAOLCA from the right aortic sinus with interarterial course, group 2: AAOLCA from the right aortic sinus with intraseptal course, and group 3: AAOLCA with a juxtacommissural origin between the left and noncoronary aortic sinus. Anatomic details were assessed using computed tomography angiography. Provocative stress testing (exercise stress testing and stress perfusion imaging) was performed in patients >8 years old or younger if concerning symptoms. Surgery was recommended for group 1 and in select cases in group 2 and group 3. We enrolled 56 patients (64% males) with AAOLCA (group 1, 27; group 2, 20; group 3, 9) at median age of 12 years (interquartile range, 6-15). Intramural course was common in group 1 (93%) compared with group 3 (56%) and group 2 (10%). Seven (13%) presented with aborted sudden cardiac death (group 1, 6/27; group 3, 1/9); 1 (group 3) with cardiogenic shock. Fourteen/42 (33%) had inducible ischemia on provocative testing (group 1, 32%; group 2, 38%; group 3, 29%). Surgery was recommended in 31/56 (56%) patients (group 1, 93%; group 2, 10%; and group 3, 44%). Surgery was performed in 25 patients at a median age 12 (interquartile range, 7-15) years; all have been asymptomatic and free from exercise restrictions at median follow-up of 4 (interquartile range, 1.4-6.3) years. Inducible ischemia was noted in all 3 AAOLCA subtypes while most aborted sudden cardiac deaths occurred in interarterial AAOLCA (group 1). Aborted sudden cardiac death and cardiogenic shock may occur in AAOLCA with left/nonjuxtacommissural origin and intramural course, thus also deemed high-risk. A systematic approach is essential to adequately risk stratify this population.

The utility of speckle-tracking echocardiography in early and midterm follow-up after anomalous origin of the left coronary artery from the pulmonary artery repair.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a reversible cause of left ventricular (LV) dysfunction in infants. The LV function is expected to improve serially and return to normal by 1 year after surgical repair. The pattern of improvement in LV function has not been serially analyzed after ALCAPA repair. We report our preliminary experience with serial assessment of LV function in infants undergoing ALCAPA repair utilizing speckle tracking echocardiography.

Incidentally Detected Anomalous Origin of Right Coronary Artery from Pulmonary Artery Associated with Atrial Septal Defect and PDA

Incidentally Detected Anomalous Origin of Right Coronary Artery from Pulmonary Artery Associated with Atrial Septal Defect and PDA

Surgical repair of the anomalous aortic origin of the coronary arteries: a single-center experience.

Anomalous aortic origin of the coronary artery is a rare congenital cardiac anomaly. The aim of this study was to present our experience with patients who underwent surgery for the anomalous aortic origin of the coronary artery. This was a retrospective review of our experience with patients who had anomalous aortic origin of the coronary artery from 2019 to 2022. Seven patients were managed for anomalous aortic origin of the coronary artery, including five males and two females. The median age of the patients were 16 years (IQR, 14.5-26 years). Five patients had anomalous aortic origin of the right coronary artery and two patients had anomalous aortic origin of the left coronary artery. Five patients were treated surgically, one patient refused surgical treatment despite myocardial ischaemia symptoms, and the other one was not operated because she had no symptoms. Two patients underwent pulmonary root anterior translocation and left main coronary artery unroofing procedure, one patient underwent right coronary artery unroofing procedure, one patient underwent pulmonary artery lateral translocation procedure, and the last patient underwent right coronary artery osteal translocation procedure. The post-operative mortality or myocardial infarction was not observed in any patient. Patients were followed for a median of 10 months (IQR, 6.75-20.5 months) after repair. The data suggest that surgical repair of anomalous aortic origin of the coronary artery can be performed confidently and can be very effective for relieving myocardial ischaemia symptoms. Different surgical techniques can be used in anomalous aortic origin of the coronary artery according to the course and origin of the coronary arteries. To the our knowledge, pulmonary root anterior translocation and coronary artery unroofing procedure were performed for the first time in the literature.

A Rare Variant of Single Coronary Artery: Anomalous Origin of Right Coronary Artery Arising from Left Anterior Descending Artery

A Rare Variant of Single Coronary Artery: Anomalous Origin of Right Coronary Artery Arising from Left Anterior Descending Artery

Treatment of Anomalous Coronary Arteries—Surgical Revascularisation Using the Pure Internal Thoracic Artery Technique

To evaluate the use of CABG utilising an isolated pedicled Right Internal Thoracic Artery (RITA) or Left Internal Thoracic Artery (LITA) or the Pure Internal Thoracic Artery (PITA) technique to treat anomalous aortic origin of coronary artery (AAOCA). A retrospective review of all patients at our institution over an 8-year period (2013-2021) who underwent surgery for AAOCA was performed. Data assessed included patient demographics, initial presentation, morphology of coronary anomaly, surgical procedure, cross-clamp time, cardiopulmonary bypass time, and long-term outcome. A total of 14 patients underwent surgery, including 11 males (78.5%) with a median logistic EuroSCORE of 1.605 (IQR 1.34). The median age was 62.5 years (IQR 48.75). Presentation was angina (7 patients), acute coronary syndrome (5 patients), incidental findings in aortic valve pathology (2 patients). AAOCA morphology varied: RCA from left coronary sinus (6), RCA from left main stem (3), left coronary artery from the right coronary sinus (1), left main stem arising from right coronary sinus (2) and circumflex artery arising from the right coronary sinus (2). Overall, 7 patients had co-existing flow-limiting coronary artery disease. CABG was performed using either a pedicled skeletonized RITA, LITA or PITA technique. There was no perioperative mortality. Overall median follow-up time was 43 months. One patient presented with recurrent angina secondary to graft failure at 2 years and there were two non-cardiac-related deaths at 4 and 35 months. The use of internal thoracic artery grafts can provide a durable treatment option in patients with anomalous coronary arteries. The potential risk of graft failure in patients with no flow-limiting disease should be very carefully considered. However, a proposed benefit of this technique is the use of a pedicle flow to increase the long-term patency. More consistent results are obtained when ischaemia can be demonstrated preoperatively.

Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Large Pediatric Cohort Medium-Term Outcomes

Anomalous aortic origin of a right coronary artery may cause myocardial ischemia and sudden death in the young. Data on myocardial ischemia or longitudinal outcomes are sparse in pediatric anomalous aortic origin of a right coronary artery population. Patients <21 years with anomalous aortic origin of a right coronary artery were prospectively enrolled. Computerized tomography angiography defined morphology. Exercise stress test and stress perfusion imaging (sPI) were performed if >7 years or younger with concern for ischemia. High-risk features included intramural length, slit-like/hypoplastic ostium, exertional symptoms, or evidence of ischemia. A total of 220 patients (60% males) were enrolled December 2012 to April 2020 at a median age 11.4 years (interquartile range, 6.1-14.5), including 168 (76%) with no/nonexertional symptoms (group 1) and 52 (24%) with exertional chest pain/syncope (group 2). Computerized tomography angiography was available in 189/220 (86%), exercise stress test in 164/220 (75%), and sPI in 169/220 (77%). Exercise stress test was positive in 2/164 (1.2%) patients in group 1, both had positive sPI. Inducible ischemia (sPI) was detected in 11/120 (9%) in group 1 and 9/49 (18%) in group 2 (P=0.09). Intramural length was similar in patients with/without ischemia (5 [interquartile range, 4-7] versus 5 [interquartile range, 4-7] mm; P=0.65). Surgery was recommended in 56/220 (26%) patients with high-risk features. In 52 surgical patients (38 unroofing, 14 reimplantation), all subjects were alive and have returned to exercise at last median follow-up of 4.6 (interquartile range, 2.3-6.5) years. Anomalous aortic origin of a right coronary artery patients can present with inducible ischemia on sPI despite symptoms or intramural length. Exercise stress test is a poor predictor of ischemia and caution should be given to determine low-risk based solely on this assessment. All patients are alive at medium-term follow-up.

Anomalous origin of the left coronary artery from the pulmonary artery: The role of CZT camera

Anomalous origin of the left coronary artery from the pulmonary artery: The role of CZT camera

Safety and Efficacy of Surgical Correction of Anomalous Aortic Origin of Coronary Arteries: Experiences from two Tertiary Cardiac Centers.

This study aims to describe the outcomes of surgical correction for anomalous aortic origin of coronary artery (AAOCA) with regard to symptom relief. We performed a retrospective multicentre study including surgical patients who underwent correction for AAOCA between 2009 and 2022. Patients who underwent concomitant cardiac procedures were also included. However, to analyze symptom relief we only assessed the subgroup of symptomatic patients who underwent isolated correction for AAOCA. A total of 71 consecutive patients (median age 55, range 12-83) who underwent surgical correction for AAOCA were included in the study. Right-AAOCA was present in 56 patients (79%), left-AAOCA in 11 patients (15%), single coronary ostium AAOCA in 4 patients (6%). Coronary unroofing was performed in 72% of the patients, coronary reimplantation in 28% and an additional neo-ostium patchplasty in 13% of the patients. In 39% of the patients a concomitant cardiac procedure was performed. During follow-up, no cardiovascular-related death was observed. Three patients (4.2%) had a myocardial infarction and underwent postoperative coronary artery bypass grafting. Six patients (8.5%) needed postoperative temporary mechanical circulatory support. Among the 34 symptomatic patients who underwent isolated AAOCA correction, 70% were completely asymptomatic after surgery, 12% showed symptom improvement and no symptom improvement was observed in 18% of the patients (median follow-up 3.5 years, range 0.3-11.1). Correction for AAOCA can be safely performed with or without concomitant cardiac procedures. Performing AAOCA correction leads to a significant improvement in symptoms for most patients.

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.