Coronary Artery Anatomy Research Articles

Evaluation of Coronary Circulation after Arterial Switch Operation.

ResumoFundamentoA avaliação da artéria coronária após a cirurgia de Jatene ainda é um desafio clínico.ObjetivoCorrelacionar alterações anatômicas identificadas por tomografia computadorizada cardíaca (TCC) com alterações fisiológicas detectadas na avaliação clínica para diagnosticar obstrução coronária no pós-operatório tardio de pacientes submetidos à cirurgia de Jatene.MétodosEste estudo incluiu 61 pacientes consecutivos com idade média de 9,4 anos que foram submetidos à cirurgia de Jatene. Os pacientes realizaram ecocardiografia, eletrocardiografia, teste cardiopulmonar do exercício, e tomografia computadorizada cardíaca para avaliação da capacidade funcional e anatomia da artéria coronária.ResultadosA tomografia computadorizada cardíaca revelou que somente 3,3% dos pacientes apresentaram estenose da artéria coronária. Esses pacientes eram assintomáticos, e não foram detectados sinais de isquemia miocárdicas pelos exames realizados.ConclusãoA incidência de anormalidades da artéria coronária é de 3,3% no seguimento tardio de nossa coorte de pacientes submetidos à cirurgia de Jatene. Não existe uma diretriz clara sobre o porquê, quando, e como esses pacientes deveriam ser rastreados, ou o que propor quando pacientes assintomáticos forem diagnosticados com obstrução coronária.

Combining the basically embryological, histological and anatomical structure of coronary arteries with the clinic

Coronary artery diseases and related clinical events are the most important causes of mortality and morbidity in the world. The diagnosis of coronary artery diseases is possible by knowing the coronary artery anatomy, embryology and histology. However, in terms of terms, anatomical names of coronary arteries differ clinically. In this article, anatomical structures on coronary angiography are presented with combining clinical terms.

Coronary Arteries: Normal Anatomy With Historical Notes and Embryology of Main Stems.

Anatomy of subepicardial coronary arteries became a topic of investigation at autopsy in Florence (Italy) by Banchi in the early twentieth century, with the discovery of dominant and balanced patterns. Thereafter, in the 60's of the same century Baroldi in Milan did post-mortem injection with spectacular three-dimensional casts. Later Sones at the Cleveland Clinic introduced selective coronary arteriography for in vivo visualization of coronary arteries. In the present chapter we show these patterns, as well as normal variants of origin and course with questionable risk of ischemia, like myocardial bridge as well as origin of the left circumflex coronary artery from the right sinus with retroaortic course. As far as embryology, the coronary arteries and veins are epicardial in origin and finally connect the former with the aorta, and the latter with the sinus venosus. At the time of spongy myocardium, intramural blood supply derives directly by the ventricular cavities, whereas later, at the time of myocardial compaction, vascularization originates from the subepicardial network. The connection of the subepicardial plexus with the aorta occurs with prongs of the peritruncal ring, which penetrate the facing aortic sinuses. Septation of truncus arteriosus is not responsible for the final position of the coronary orifices. Infact in transposition of the great arteries coronary ostia are regularly located within facing sinuses of the anterior aorta.

Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort

ObjectivesTo evaluate computed tomography fractional flow reserve (FFRCT) values in distal parts of the coronaries in an asymptomatic cohort of marathon runners without any coronary stenosis for potentially false-positive values.MethodsNinety-eight asymptomatic male marathon runners (age 53 ± 7 years) were enrolled in a prospective monocentric study and underwent coronary computed tomography angiography (CCTA). CCTA data were analyzed for visual coronary artery stenosis. FFRCT was evaluated in 59 participants without coronary artery stenosis in proximal, mid, and distal coronary sections using an on-site software prototype.ResultsIn participants without coronary artery stenosis, abnormal FFRCT values ≤ 0.8 in distal segments were found in 22 participants (37%); in 19 participants in the LAD; in 5 participants in the LCX; and in 4 participants in the RCA. Vessel diameters in participants with FFRCT values > 0.80 compared to ≤ 0.80 were 1.6 ± 0.3 mm versus 1.5 ± 0.3 mm for distal LAD (p = 0.025), 1.8 ± 0.3 mm versus 1.6 ± 0.5 mm for distal LCX (p = 0.183), and 2.0 ± 0.4 mm versus 1.5 ± 0.2 mm for distal RCA (p < 0.001).ConclusionsAbnormal FFRCT values of ≤ 0.8 frequently occurred in distal coronary segments in subjects without any anatomical coronary artery stenosis. This effect is only to some degree explainable by small distal vessel diameters. Therefore, the validity of hemodynamic relevance evaluation using FFRCT in distal coronary artery segment stenosis is reduced.Key Points• Abnormal FFRCT values (≤ 0.8) occurred in over a third of the subjects in the distal LAD despite the absence of coronary artery stenosis..• Therefore, the validity of hemodynamic relevance evaluation in distal coronary artery segment stenosis is reduced.• Decision-making based on abnormal FFRCT values in distal vessel sections should be performed with caution and only in combination with visual assessment of the grade of stenosis..

Long-term outcome after the arterial switch operation: 43 years of experience.

OBJECTIVESThe objective of this study was to assess our 43-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) by analysing cardiac outcome measures (hospital and late mortality, reoperations and catheter interventions, significant coronary artery obstruction) and to identify risk factors for reoperation and catheter interventions. METHODSA total of 490 patients who underwent ASO for TGA from 1977 to 2020 were included in this retrospective, single-centre study. Data on reoperation and catheter intervention of hospital survivors were estimated by the Kaplan–Meier method and compared using a long-rank test. Risk factors for reoperation and/or catheter intervention were assessed by multivariate Cox regression analysis.RESULTSHospital mortality occurred in 43 patients (8.8%), late death in 12 patients (2.9%) and 43 patients were lost to follow-up. Median follow-up time of 413 hospital survivors was 15.6 (interquartile range 7.0–22.4) years. Reoperations were performed in 83 patients (117 reoperations). Neoaortic valve regurgitation with root dilatation was the second most common indication for reoperation (15/83 patients, 18.1%) after right ventricular outflow tract obstruction (50/83 patients, 60.2%). Risk factors for any reoperation on multivariable analysis were: TGA morphological subtype [TGA with ventricular septal defect: hazard ratio (HR) = 1.99, 95% confidence interval (CI) 1.18–3.36; P = 0.010 and Taussig-Bing: HR = 2.17, 95% CI 1.02–4.64; P = 0.045], aortic arch repair associated with ASO (HR = 3.03, 95% CI 1.62–5.69; P = 0.001) and a non-usual coronary artery anatomy (HR = 2.41, 95% CI 1.45–4.00; P = 0.001). One hundred and one catheter interventions were performed in 54 patients, usually for relief of supravalvular pulmonary stenosis (44/54 patients, 81.5%) or arch obstruction (10/54 patients, 18.5%). Main risk factor for catheter intervention on multivariable analysis was aortic arch repair associated with ASO (HR = 2.95, 95% CI 1.37–6.36; P = 0.006). Significant coronary artery stenosis was relatively uncommon (9/413 patients, 2.2%) but may be underrepresented.CONCLUSIONSPatients after ASO typically have good long-term clinical outcomes but reoperations and interventions remain necessary in some patients. Neoaortic valve regurgitation with root dilatation is the second most common indication for reoperation after right ventricular outflow tract obstruction and an increasing need for neoaortic valve and root redo surgery in future is to be expected.

Using EKG to Confirm MI in Mouse Model of Permanent Left Anterior Descending Coronary Artery

The variability in coronary artery anatomy and branching of the left coronary artery can affect reproducibility of myocardial infarction (MI) surgery, even with occlusion at a constant anatomic site. Blanching and discoloration of the left ventricle (LV) are common variables used to confirm a successful MI surgery. Determining a way to improve precision will improve the standard surgical approaches to simulate MI in mice, thus reducing the number of experimental animals necessary for statistically relevant studies. In this study, we hypothesized that using a threshold change in electrocardiography (EKG) can verify correct ligation and successful MI surgery. Using the Indus Rodent Surgical Monitor+, we measured the EKG pre and 30 sec post-MI in C57Bl6/J mice (n=13). Mice were grouped based on infarct size determined by Tetrazolium chloride (TTC) staining (n=8 with infarct ≥35%; n=5 with infarct ˂ 35%). Area under the QRS curve (p=0.008) and ST elevation (p=0.009) were significantly different pre versus post-MI in mice that had at least 35% infarct. No correlation was observed between infarct size and change in area under the QRS complex (R2=0.205; p=0.308) nor ST elevation (R2=0.089; p=0.516). Receiver operating characteristic (ROC) curve analysis demonstrated that the change in ST elevation could accurately predict MI surgery success (Area= 0.84; p=0.062). In conclusion, our data demonstrates that changes in voltage of the ST segment can predict accuracy of MI surgery.

Single left coronary ostium with a prepulmonic right coronary artery course in a French Bulldog with congenital valvular pulmonary stenosis

A two-year-old, male castrated, French bulldog was presented for evaluation of coronary artery anatomy before balloon valvuloplasty for severe pulmonic valve stenosis. Multidetector computed tomography angiography showed a single left coronary ostium, absent right coronary ostium, and an anomalous, prepulmonic coursing right coronary artery. Medical management was elected to avoid the attendant risk associated with intervention. This case report documented the first known case of this specific anomaly in French bulldogs. Veterinary cardiologists should be aware of the potential for this specific coronary artery anomaly in this breed, given the predilection for the development of pulmonary stenosis. Routine screening of French bulldogs for anomalous, prepulmonic coronary arteries is recommended before interventional balloon valvuloplasty.

Effect of Presence of Ramus Intermedius Artery on Location of Culprit Lesions in Acute Left Circumflex Coronary Artery Occlusion.

Background and aimCoronary artery anatomy frequently affects location of atherosclerotic plaques and subsequent culprit lesions. We sought to clarify whether presence or absence of Ramus Intermedius coronary artery (RI) would affect location of culprit lesions in acute left circumflex (LCX) coronary artery occlusion.MethodsThe study included 180 patients, 100 with a diagnosis of non-ST elevation myocardial infarction (NSTEMI) and 80 with ST elevation myocardial infarction (STEMI). All culprit lesions were located in the LCX coronary artery. RI group included 45 patients and the No RI group included 135 patients.ResultsCulprit LCX lesions were similarly located at a comparable distance from LCX ostium in both groups and the presence of RI was not associated with significantly more proximally located culprit LCX lesions (34.7 ± 15.2 mm compared to 30.8 ± 17.9 mm respectively, p > 0.05). The frequency distribution of culprit lesions’ distance from LCX ostium showed no significant difference between both groups in any of the segments studied (10 mm each). There was no significant difference between both groups regarding markers of myocardial necrosis size as cardiac biomarkers (peak cardiac troponin-T 1077.4 ± 361.2 pg/dl vs 926 ± 462.2 pg/dl respectively, p = 0.13), (peak creatine kinase-MB 232.2 ± 81 ng/dl vs 194.7 ± 99.2 ng/dl respectively, p = 0.07) or left ventricular ejection fraction (EF 46.3 ± 6.3% vs 48.3 ± 8.3% respectively, p = 0.76).ConclusionPresence of RI coronary artery, as an additional flow divider, may not be associated with more proximal culprit lesions, compared to its absence, in cases of acute LCX coronary artery occlusion. Possible underlying pathophysiologic mechanisms remain to be clarified.

The importance of heart and brain imaging in children and adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C).

Multisystem Inflammatory Syndrome in Children (MIS-C) recently reported in a minority of children affected by SARS-CoV-2, mimics Kawasaki disease (KD), a medium vessel vasculitis of unknown cause. In contrast to acute COVID-19 infection, which is usually mild in children, 68% of patients with MIS-C will need intensive care unit. Myocarditis and coronary artery ectasia/aneurysm are included between the main cardiovascular complications in MIS-C. Therefore, close clinical assessment is need it both at diagnosis and during follow-up. Echocardiography is the cornerstone modality for myocardial function and coronary artery evaluation in the acute phase. Cardiovascular magnetic resonance (CMR) detects diffuse myocardial inflammation including oedema/fibrosis, myocardial perfusion and coronary arteries anatomy during the convalescence and in adolescents, where echocardiography may provide inadequate images. Brain involvement in MIS-C is less frequent compared to cardiovascular disease. However, it is not unusual and should be monitored by clinical evaluation and brain magnetic resonance (MRI), as we still do not know its effect in brain development. Brain MRI in MIS-C shows T2-hyperintense lesions associated with restricted diffusion and bilateral thalamic lesions. To conclude, MIS-C is a multisystem disease affecting many vital organs, such as heart and brain. Clinical awareness, application of innovative, high technology imaging modalities and advanced treatment protocols including supportive and anti-inflammatory medication will help physicians to prevent the dreadful complications of MIS-C.

Relationship of Stress Test Findings to Anatomic or Functional Extent of Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve.

Background In the United States, functional stress testing is the primary imaging modality for patients with stable symptoms suspected to represent coronary artery disease (CAD). Coronary computed tomography angiography (CTA) is excellent at identifying anatomic coronary artery disease (CAD). The application of computational fluid dynamics to coronary CTA allows fractional flow reserve (FFR) to be calculated noninvasively (FFRCT). The relationship of noninvasive stress testing to coronary CTA and FFRCT in real-world clinical practice has not been studied. Methods We evaluated 206 consecutive patients at Loyola University Chicago with suspected CAD who underwent noninvasive stress testing followed by coronary CTA and FFRCT when indicated. Patients were categorized by stress test results (positive, negative, indeterminate, and equivocal). Duke treadmill score (DTS), METS, exercise duration, and chest pain with exercise were analyzed. Lesions ≥ 50%stenosis were considered positive by coronary CTA. FFRCT < 0.80 was considered diagnostic of ischemia. Results Two hundred and six patients had paired noninvasive stress test and coronary CTA/FFRCT results. The median time from stress test to coronary CTA was 49 days. Average patient age was 60.3 years, and 42% were male. Of the 206 stress tests, 75% were exercise (70% echocardiographic, 26% nuclear, and 4% EKG). There were no associations of stress test results with CAD > 50% or FFRCT < 0.80 (p = 0.927 and p = 0.910, respectively). Of those with a positive stress test, only 30% (3/10) had CAD > 50% and only 50% (5/10) had FFRCT < 0.80. Chest pain with exercise did not correlate with CAD > 50% or FFRCT < 0.80 (p = 0.66 and p = 0.12, respectively). There were no significant correlations between METS, DTS, or exercise duration and FFRCT (r = 0.093, p = 0.274; r = 0.012, p = 0.883; and r = 0.034, p = 0.680; respectively). Conclusion Noninvasive stress testing, functional capacity, chest pain with exercise, and DTS are not associated with anatomic or functional CAD using a diagnostic strategy of coronary CTA and FFRCT.

Coronary artery anomalies in tetralogy of Fallot patients evaluated by multi slice computed tomography; myocardial bridge is not a rare finding.

Based on coronary angiography and interoperative inspection, anomalous origin of coronary artery crossing the right ventricular outflow tract (RVOT) is common in tetralogy of Fallot (TOF) patients. However, other coronary anomalies may be underestimated due to the overlying myocardium, epicardial fat, or adhesions due to previous palliative surgery. Currently, coronary artery visibility dramatically improved by multislice computed tomography (MSCT). We performed this study to assess the coronary arteries anatomy in TOF patients using MSCT.All TOF patients underwent MSCT examination at our centre from 2013 till 2019 were included. Assessment of the coronary arteries’ origin and course were performed. Presence of myocardial bridge were assessed, and indexed RV mass was calculated.318 TOF patients were included, median age 2 years (range 1 month–46 years), 175 males (55%). The abnormal coronary artery origin and course were detected in 20 patients (6%); coronary artery crossed RVOT in 13 patients (65%), 5 patients (25%) had a retro-aortic course and 2 patient (10%) had inter-arterial course. Myocardial bridges of left anterior descending artery or/and right coronary artery were reported in 100 patients (36%), no myocardial bridge of left circumflex was reported. RV mass was 29.0 ± 21.1 g/m2. There was no correlation between RV mass and presence of myocardial bridges.MSCT is a useful imaging modality for detection of coronary arteries anomalies in TOF patients. Coronary artery crossing RVOT is not the only abnormal course and myocardial bridging is not a rare finding. Further studies are needed to demonstrate the clinical significance of these observations.

Anomalous Right Coronary Originating from the Left main Coronary or the mid of Left Anterior Descending Coronary Artery

Coronary artery anomalies (CAAs) are very rare a relatively uncommon, diverse group of congenital disorders of coronary arterial anatomy with a clinical presentations. Though most commonly detected incidentally finding during routine catheter, CT angiograms or at autopsy, these anomalies have generated considerable interest as they constitute the second most common cause of sudden cardiac death in young competitive athletes after hypertrophic cardiomyopathy1. Their prevalence ranges from 0.2% to 1.3% based published series 2-4. The most common coronary artery anomaly is origination of the left circumflex coronary (LCX) artery from the proximal of right coronary artery (RCA) or right sinus of Valsalva. The second is separate origination of the left anterior descending coronary artery (LAD) and LCX artery from the left sinus of Valsalva. Herein, we present five cases that the anomalous RCA arises from the left main coronary artery or the mid of left left anterior descending coronary artery (LAD). These cases are extremely rare. we bring forth them in an attempt to highlight their significance, and make cardiologist to understand what important the anomalies are, and how to diagnosis and treatment these bifurcation lesions of coronary anomalies.

CLINICAL FEATURES OF PATIENTS WITH CORONARY ARTERY ECTASIA COMPARED WITH STENOTIC CORONARY ARTERY DISEASE

Objective: To study the prevalence of coronary artery ectasia in the population of patients referred for coronary angiography. To describe clinical characteristics of patients with coronary artery ectasia, analyzing presentation and cardiovascular risk. To compare clinical and angiographic variables in patients with and without coronary artery ectasia.&#x0D; Study Design: Descriptive cross sectional study.&#x0D; Place and Duration of Study: Adult cardiology department in Armed Forces Institute of Cardiology/NIHD, Rawalpindi, 6 months duration after approval of synopsis i.e. Oct 2018 to May 2019.&#x0D; Methodology: After meeting the inclusion criteria 300 patients were enrolled. Patients admitted in AFIC/NIHD with chest pain, ST-elevation MI, Non-ST-elevation myocardial infarction and unstable angina were enrolled. Coronary angiogram was done by cardiologist. Two distinct cardiologists or resident cardiologists reported the angiograms including the coronary artery anatomy and the presence of ectatic segments or any stenotic lesions in each vessel. All the collected data was entered and analyzed on SPSS version 23.&#x0D; Results: The mean patients was 58.23 ± 11.73 years. The male to female ratio was 14:1. Coronary artery ectasia was detected in 53 (17.7%) patients of coronary angiography. Stenotic coronary artery disease was detected more commonly in patients having factors like diabetes, hypertension, and dyslipidemia but specifically among smokers, ectatic segments were detected higher.&#x0D; Conclusion: Compared to coronary artery disease, coronary ectasia occurred more in smokers and less in diabetes.

Prenatal Delineation of Coronary Anatomy in Dextro-Transposition of Great Arteries.

Background:Dextro-transposition of the great arteries (D-TGA) is the second-most common cyanotic congenital heart disease with variable coronary artery anatomy. The arterial switch procedure has revolutionized outcomes for this defect, with coronary anatomy being a key determinant of both short- and long-term outcomes following surgical repair. The assessment of coronary anatomy is usually undertaken in the postnatal period by transthoracic echocardiography, with assessment prenatally not being well studied. We sought to assess the feasibility of delineating the coronary arteries on fetal echocardiograms in a small cohort of patients followed prenatally.Methods:This was a retrospective review of fetuses with D-TGA from 2008 to 2018. Patients with prenatal diagnosis of D-TGA were reviewed for the assessment of coronary artery anatomy. Details of coronary artery anatomy diagnosed prenatally were compared with postnatal transthoracic echocardiograms and intraoperative findings.Results:Thirty-four fetuses with findings of D-TGA on prenatal echocardiograms were reviewed. 14/34 fetuses had attempted delineation of coronary artery anatomy, with average gestational age of 28 weeks (range 23–31 weeks) at the time of diagnosis. Two-dimensional and color Doppler imaging of the coronary arteries on both short and long axis images were performed, with complete delineation being possible in ~ 86% of fetuses. These findings were confirmed postnatally.Conclusions:Fetuses with D-TGA can have variable coronary artery anatomy which drives postnatal outcomes. Our study describes a cohort of patients with D-TGA wherein coronary artery anatomy was assessed. We demonstrate that coronary artery evaluation is feasible prenatally with optimal imaging techniques, being more successful after 25 weeks' gestation. The potential knowledge of dangerous variants can help with referral to centers of excellence for appropriate postnatal management and facilitate prenatal care accordingly.

Особенности атеросклеротического поражения коронарных артерий у пациентов с ранним развитием острого коронарного синдрома среди носителей различных полиморфных вариантов генов ангиогенеза

The purpose was to examine atherosclerotic changes in the anatomy of coronary arteries in patients with early acute coronary syndrome among carriers of different genotypes: rs3825807 of the ADAMTS7 gene and rs699947 of the VEGF-A gene.The study included 116 patients, 69 (59%) men and 47 (41%) women with the first manifestation of acute coronary syndrome (ACS) before 55 years and 65 years respectively. Coronary angiography revealed at least one stenosis ≥ 40% in all patients during in-house treatment. The genotype of rs3825807 ADAMTS7 gene and rs699947 VEGF-A gene was determined by PCR in all patients. The prevalence of CC genotype rs699947 VEGF-A gene in patients with left circumflex artery stenosis was less than in patients without such a lesion (0.26 versus 0.46, p = 0,03; OR = 0,419; 95% CI: 0,187–0,941). The prevalence of TT genotype rs3825807 ADAMTS7 gene in patients with early manifestation of ACS with stenosis of the posterior basal branch and posterior interventricular branch of the right coronary artery was significantly higher (0,78 versus 0,35, p = 0,027) than in patients without these lesions (OR = 6,36; 95% CI: 1,27–32,59). Thus, with the development of acute coronary syndrome in men up to 55 years old, in women up to 65 years old, the carriage of the Аallele rs699947 VEGF-A gene is associated with lesions of left circumflex artery, and the carriage of TT genotype rs3825807 ADAMTS7 gene is associated with lesions of the posterior interventricular branch and the posterior basal branch of the right coronary artery.

Primary Percutaneous Coronary Intervention in an Anomalous Left Circumflex Artery: Search for the Hidden Culprit

Congenital coronary anomalies are rarely detected in patients undergoing diagnostic coronary angiography. They pose a challenge in delay to identify the anomalous artery as well as difficulty in engaging the anomalous vessel. The present case report was of 56-years-old male patient presented with acute onset of chest pain. On evaluation, his electrocardiogram was suggestive of ST segment elevation in inferior leads. He underwent diagnostic coronary angiogram which revealed totally occluded Left Circumflex Artery (LCx) arising anomalously from right coronary osteum. Primary Percutaneous Coronary Intervention (PCI) of LCx could not be performed with routine guide catheters necessitating the use of special multipurpose guide catheter with balloon support. The case highlights the need for the knowledge of coronary anatomy and anomalous origins of coronary arteries and the selection of appropriate guiding catheters and coronary wires.

Demonstration of coronary arterial anatomy on CTCA, with particular focus on aberrant courses

Category: Cardiac

Cardiac CT perfusion and FFRCTA: pathophysiological features in ischemic heart disease.

Cardiac computed tomography (CCT) has rapidly evolved, becoming a powerful integrated tool for the evaluation of coronary artery disease (CAD), and being superior to other noninvasive methods due to its high accuracy and ability to simultaneously assess both lumen stenosis and atherosclerotic plaque burden. Furthermore, CCT is regarded as an effective gatekeeper for coronary angiography, and carries independent important prognostic information. In the last decade, the introduction of new functional CCT applications, namely CCT perfusion (CCTP) imaging and CT-derived fractional flow reserve (FFRCTA), has opened the door for accurate assessment of the haemodynamic significance of stenoses. These new CCT technologies, thus, share the unique advantage of assessing both myocardial ischemia and patient-specific coronary artery anatomy, providing an integrated anatomical/functional analysis. In the present review, starting from the pathophysiology of myocardial ischemia, we evaluate the existing evidence for functional CCT imaging and its value in relation to alternative, well-established, non-invasive imaging modalities and invasive indices of ischemia (currently the gold-standard). The knowledge of clinical applications, benefits, and limitations of these new CCT technologies will allow efficient and optimal use in clinical practice in the near future.

Abstract 14443: Aortic Root Rotational Position Associates With Aortic Valve Incompetence and Aortic Dilation After Arterial Switch Operation for Transposition of the Great Arteries

Introduction: Variation in aortic root (AoR) rotational position affects flow dynamics in normal patients. Complications of arterial switch operation (ASO) for transposition of the great arteries (TGA) include aortic dilation and neo-aortic regurgitation (AR). We sought to assess the association of neo-AoR rotational position with neo-AoR and ascending aorta (AA) dilation and neo-AR in TGA after ASO. Methods: Patients after ASO for TGA who underwent cardiac magnetic resonance (CMR) from 2005-2020 were retrospectively reviewed. Neo-AoR rotational angle, indexed (to height) neo-AoR and AA dimensions, indexed left ventricular end diastolic volume (LVEDVi), and neo-aortic regurgitant fraction (RF) were obtained from CMR. Multivariable regression analysis for neo-AoR and AA dilation, RF, and LVEDVi were performed. Results: A total of 36 patients (78% male) were included. Median age at ASO was 5 days (3, 7) and at CMR was 17.1 years (12.3, 21.9). Rotational angle was 25% counterclockwise (&lt;-9°), 25% central (-9 to +14°), and 50% clockwise (&gt;+15°). There was no material association of neo-AoR and AA size with sex, age, and coronary artery anatomy. A quadratic term for neo-AoR rotational angle - increasing extremes of counterclockwise and clockwise angles - was significantly associated with neo-AoR dilation (p=0.03), AA dilation (p&lt;0.02), and LVEDVi (p&lt;0.01) (Figure 1) and remained significant in multivariable model of neo-AoR dilation (p&lt;0.02), AA dilation (p&lt;0.01), and LVEDVi (p&lt;0.02). Rotational angle was negatively associated with neo-aortic RF (p&lt;0.05) and remained significant in multivariable model (p&lt;0.02). Conclusions: In conclusion, both clockwise and counterclockwise neo-AoR rotational position in TGA after ASO are associated with neo-AoR and AA dilation and LVEDVi. Counterclockwise rotational angle was associated with RF. Neo-AoR rotational position likely affects valve function and hemodynamics, leading to risk of neo-AR and aortic dilation.

Non-invasive imaging techniques to assess myocardial perfusion

ABSTRACT Introduction Coronary artery disease affecting myocardial perfusion continues to be the leading cause of cardiovascular morbidity and mortality worldwide. While invasive evaluation based on coronary angiography and flow measurements still is considered the reference technique for assessing myocardial perfusion, technological evolutions in noninvasive imaging techniques resulted in them playing a more important role in assessing myocardial perfusion influencing therapeutic decision-making and prognostication. Areas covered Different imaging modalities are used to evaluate coronary perfusion, including echocardiography, coronary computerized tomography scan, magnetic resonance imaging, and nuclear myocardial perfusion imaging. Through a combination of different techniques, it is possible to describe coronary artery anatomy and the diameter of the epicardial vessels but more recently also of the coronary microcirculation. Quantification of myocardial perfusion is feasible both at baseline and during pharmacological or physiological stress. Expert opinion The objective of this state-of-the-art paper is to review the recent evolutions in imaging methods to estimate myocardial perfusion and to discuss the diagnostic strengths and limitations of the different techniques. The new ultrasound technologies and the hybrid approaches seem to be the future is these fields.