Coronary Artery Anomalies Research Articles

Myocardial bridges in a pediatric population: Outcomes following a standardized approach

ObjectiveTo describe clinical, functional, surgical, and outcomes data in pediatric patients with a myocardial bridge (MB) evaluated and managed following a standardized approach. MethodsProspective observational study included patients evaluated in the Coronary Artery Anomalies Program. Anatomy was determined by computed tomography angiography, myocardial perfusion by stress perfusion imaging, and coronary hemodynamic assessment by cardiac catheterization. ResultsIn total, 39 of 42 patients with a complete evaluation for MB were included (December 2012 to June 2022) at a median age of 14.1 years (interquartile range, 12.2-16.4). Sudden cardiac arrest occurred in 3 of 39 (8%), exertional symptoms in 14 (36%), and no/nonspecific symptoms in 7 (18%) patients. Exercise stress test was abnormal in 3 of 34 (9%), stress perfusion imaging in 8 of 34 (24%), and resting instantaneous wave-free ratio ≤0.89 or diastolic dobutamine fractional flow reserve ≤0.80 in 11 of 21 (52%) patients. As a result, 15 of 39 (38%) patients were determined to have hemodynamically significant MB, 1 of 15 patients started beta-blocker, and 14 of 15 were referred for surgery. Myotomy (n = 11) and coronary bypass (n = 1) were performed successfully, resulting in improved symptoms and stress testing results. One patient required pericardiocentesis postoperatively, and all were discharged without other complications. At median follow-up time of 2.9 (1.8-5.8) years, all (except 2 pending surgery) were doing well without exercise restriction. ConclusionsPediatric patients with MB can present with myocardial ischemia and sudden cardiac arrest. Provocative stress test and intracoronary hemodynamic tests helped risk-stratify symptomatic patients with MB and concern for ischemia. Surgical repair was safe and effective in mitigating exertional symptoms and stress test results, allowing patients to return to exercise without restriction.

Clinical Presentation and Therapy of Coronary Artery Anomalies.

There are two major coronary arteries that arise normally directly above the aortic valve in the sinus. The left main coronary artery (LCA or LMCA) arises from the left coronary sinus and divides shortly after its origin into the left anterior descending and the circumflex coronary arteries (LCX). Branches of the left anterior descending (LAD) coronary artery include the left conus, septal, and diagonal arteries. Branches of the circumflex coronary artery may include the sinus node artery, Kugel's artery, marginal arteries, and the left atrial circumflex artery (Fig. 47.1). The LAD follows the interventricular septum to the apex, the LCX turns posterior, follows the atrioventricular groove between the left atrium and ventricle to the coronary sinus. Branches of the right coronary artery (RCX) include the conal branch, the sinus node artery, an atrial branch, the right ventricular muscle branches (including the acute marginal branch), the posterior descending coronary artery, the atrioventricular node artery, and septal branches (Fig. 47.2). The RCX follows the atrioventricular groove between the right atrium and ventricle. The "dominant coronary artery" is the one giving rise to the posterior descending coronary artery. It originates from the right coronary artery in 80% of people.

Comparison between diaphragmatic-navigated and self-navigated coronary magnetic resonance angiography at 3T in pediatric patients with congenital coronary artery anomalies.

Coronary magnetic resonance angiography (CMRA) is being increasingly used in pediatric patients with congenital coronary artery anomalies (CAAs). However, the data on the free-breathing self-navigation technique, which has the potential to simplify the acquisition plan with a high success rate at 3T, remain scarce. This study investigated the clinical application value of self-navigated (sNAV) CMRA at 3T in pediatric patients with suspected CAAs and compared it to conventional diaphragmatic-navigated (dNAV) CMRA. From April 2019 to March 2022, we enrolled 65 pediatric patients (38 males and 27 females; mean age 8.5±4.4 years) with suspected CAAs in this prospective study. All patients underwent both dNAV and sNAV sequences in random order with gradient recalled echo (GRE) sequence during free breathing, with 39 (20 males and 19 females; mean age 10.2±3.6 years) of them additionally undergoing coronary computed tomography angiography (CCTA) or invasive coronary angiography (ICA). We measured and compared the success rate, scan time, visual score of the 9 main coronary artery segments, vessel sharpness, and vessel length between the two sequences. The diagnostic accuracy was compared using CCTA or ICA as a reference. The success rate of sNAV-CMRA (65/65, 100%) was higher than that of dNAV-CMRA (61/65, 93.8%) (P<0.001), and the scan time of sNAV-CMRA (7.3±2.5 min) was significantly shorter than that of dNAV-CMRA (9.1±3.6 min) (P=0.002). The acquisition efficiency of dNAV-CMRA was 40.5%±12.9%, while for sNAV-CMRA, 100% acquisition efficiency was achieved. There was no significant difference in vessel length of any of the coronary arteries, visual score, or vessel sharpness of the left circumflex coronary artery (LCX) between the two sequences (all P values >0.050). The visual score and vessel sharpness of the right coronary artery and left anterior descending coronary artery (LAD) were significantly improved in dNAV-CMRA compared with sNAV-CMRA (all P values <0.050). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of CAAs were not significantly different between the two sequences (all P values >0.050). Our findings demonstrated that both sNAV and dNAV in CMRA provide clinical application value in pediatric patients with CAAs and have similar diagnostic performance. Although the image quality of sNAV-CMRA is slightly inferior compared to that of dNAV-CMRA, sNAV-CMRA allows for a simpler scanning procedure.

Congenital Coronary Blood Vessel Anomalies: Animal Models and the Integration of Developmental Mechanisms.

Coronary blood vessels are in charge of sustaining cardiac homeostasis. It is thus logical that coronary congenital anomalies (CCA) directly or indirectly associate with multiple cardiac conditions, including sudden death. The coronary vascular system is a sophisticated, highly patterned anatomical entity, and therefore a wide range of congenital malformations of the coronary vasculature have been described. Despite the clinical interest of CCA, very few attempts have been made to relate specific embryonic developmental mechanisms to the congenital anomalies of these blood vessels. This is so because developmental data on the morphogenesis of the coronary vascular system derive from complex studies carried out in animals (mostly transgenic mice), and are not often accessible to the clinician, who, in turn, possesses essential information on the significance of CCA. During the last decade, advances in our understanding of normal embryonic development of coronary blood vessels have provided insight into the cellular and molecular mechanisms underlying coronary arteries anomalies. These findings are the base for our attempt to offer plausible embryological explanations to a variety of CCA as based on the analysis of multiple animal models for the study of cardiac embryogenesis, and present them in an organized manner, offering to the reader developmental mechanistic explanations for the pathogenesis of these anomalies.

Sudden Cardiac Death in Adolescent Athletes and the Role of Genetic Screening : A Literature Review

Sudden death, particularly among seemingly healthy individuals, presents a critical challenge in both medical and athletic communities. This literature review investigates sudden cardiac death (SCD) in adolescent athletes, emphasizing the role of genetic screening. Utilizing various studies from 2019 to 2024, the review highlights that SCD, while rare, often stems from cardiovascular issues such as cardiomyopathy and coronary artery anomalies. Pre-participation screening, including ECGs, is crucial in identifying at-risk individuals, yet raises ethical debates regarding athlete disqualification. Genetic factors play a significant role, with inherited heart conditions frequently implicated in SCD cases. Comprehensive genetic screening and family evaluations are vital, although widespread implementation is hindered by limited positive outcomes and potential psychosocial effects. Epidemiological studies reveal a higher incidence of SCD during competitive sports, underscoring the need for tailored prevention strategies. Findings emphasize the importance of multidisciplinary collaboration in enhancing screening methods, risk assessment, and preventive interventions to mitigate sudden mortality in young athletes. The study concludes that lifestyle modifications, promoted by health organizations, and advancements in genetic diagnosis are essential in improving the health and safety of athletes. Efforts to integrate cardiovascular and genetic screening into clinical and athletic practice are paramount, aiming to reduce the incidence of SCD and enhance the well-being of young athletes globally.

Prevalence and characteristics of coronary artery anomalies (CAAS) in 3016 symptomatic adult participants undergoing coronary computed tomography angiography (CCTA): A single-center retrospective study in Iran.

Coronary artery anomalies (CAAs) are associated with an increased risk of cardiovascular events, including sudden cardiac death, especially in young people. A different prevalence has been reported based on the USED diagnostic modality. This study aimed to determine the prevalence and type of these anomalies using coronary computed tomography angiography (CCTA). This single-center retrospective study was performed on 3016 consecutive cases who underwent CCTA for cardiac symptoms from March 2015 to August 2020 and the prevalence and types of CAAs were evaluated. 38 cases (overall prevalence of 1.26%) including 21 men (55.3%) and 17 women (44.7%) were retrospectively diagnosed with CAAs. The most common anomalies were the Anomalous origin of LCX from the right coronary sinus (11 cases, 28.9%), Anomalous origin of RCA from the left coronary sinus (11 cases, 28.9%), and Anomalous origin of LM from the right coronary sinus (6 cases, 15.8%). There was no difference in the prevalence of CAAs in terms of patient's gender (P value=0.16) and age (P value=0.61). The prevalence of CAAs among patients who underwent CCTA was 1.26%. The most common anomalies observed were the anomalous origin of the LCX arising from the right coronary sinus, the anomalous origin of the RCA arising from the left coronary sinus, and the anomalous origin of the LM arising from the right coronary sinus. These findings emphasize the importance of CCTA in detecting and characterizing coronary artery anomalies, which may have clinical implications for patient management and treatment decisions.

Heart Dominated by Solitary Coronary: A Case Report

The prevalence of coronary artery anomalies has been detected in 0.6% to 1.5% of coronary angiography. They are found since birth but usually with no significant symptoms and it does not generally manifest as myocardial ischemia however, malignant outcomes have been reported. Single coronary arteries are rare congenital anomalies in which the entire circulation for the heart is supplied by a coronary artery originating from a single ostium. It is challenging to recognize the anomaly of the patient’s coronaries, experiencing percutaneous coronary intervention (PCI) procedure, undergoing coronary artery surgery, or receiving a prosthetic valve replacement. In our case, we document a patient who underwent PCI for multi-vessel coronary lesions and in whom the atypical origin of the single left coronary artery, with the right coronary artery (RCA) emerging from the distal left circumflex artery (LCX), which was previously undetected.

Abstract B042: Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart?

Abstract Introduction: Congenital coronary artery anomalies can increase the risk of sudden cardiac death, especially during exercise. Cancer patients with concurrent coronary artery disease face higher mortality rates due to delayed percutaneous coronary intervention. Furthermore, anthracycline chemotherapy, a common cancer treatment, can worsen pre-existing cardiac abnormalities. Despite the complexity of managing cancer patients with coronary artery anomalies, there is a lack of clear guidelines. This report presents a case of malignant interarterial course of the right coronary artery in a patient with Human T-lymphotropic virus type I-associated adult T-cell leukemia/lymphoma and discusses the challenges of chemotherapy in such cases. Case presentation: A 38-year-old male presented with weakness and palpitations. Laboratory findings revealed abnormalities, including elevated troponin and severe narrowing of the right coronary artery. Electrocardiograms showed ST elevations initially, followed by T-wave inversions. Although the patient had a pre-existing coronary anomaly, chemotherapy was initiated due to life-threatening tumor lysis syndrome and refractory lactic acidosis. Cardiac catheterization or surgical intervention was not possible due to comorbidities. A follow-up echocardiogram after six months of chemotherapy showed no acute changes. Discussion: Managing cancer patients with congenital coronary artery anomalies is challenging. Malignant interarterial course of the right coronary artery is particularly concerning due to the risk of sudden cardiac death. In this case, the patient's symptoms and abnormal electrocardiogram led to the identification of the coronary anomaly. However, immediate intervention was not feasible due to the patient's critical condition. The initiation of anthracycline-based chemotherapy in this patient posed a dilemma. Anthracyclines can cause cardiotoxicity, worsening pre-existing cardiac anomalies. Despite the lack of guidelines, chemotherapy was administered due to the urgent need for cancer treatment. Regular monitoring was essential to detect any cardiac changes. Conclusion: Managing cancer patients with coronary artery anomalies and administering anthracycline chemotherapy remains challenging due to limited guidelines. The case highlights the importance of recognizing and managing these anomalies to reduce the risk of sudden cardiac death. Guidelines for managing cardiac complications in cancer patients with pre-existing anomalies are needed. Further research is necessary to provide evidence-based guidance for such cases. Citation Format: Aliya M. Khan. Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B042.

Abstract B043: Challenges in managing cancer patients with congenital coronary artery anomalies: A case report

Abstract Introduction: Congenital coronary artery anomalies are rare cardiac abnormalities that can increase the risk of sudden cardiac death, particularly during exercise. Patients with cancer and concurrent coronary artery disease face higher mortality risks, as they often receive delayed percutaneous coronary intervention. Additionally, anthracycline chemotherapy, commonly used in cancer treatment, can cause cardiotoxicity and worsen pre-existing cardiac abnormalities. Despite the complexity of managing cancer patients with coronary artery anomalies, there is a lack of clear guidelines and consensus on optimal approaches. This report presents a unique case of a patient with a malignant inter-arterial course of the right coronary artery and newly diagnosed Human T-lymphotropic virus type I-associated adult T-cell leukemia/lymphoma, discussing the challenges and implications of chemotherapy in such cases. Case Presentation: A 38-year-old male presented with weakness and palpitations, exhibiting abnormal laboratory findings. CT angiography revealed a malignant inter-arterial course of the right coronary artery with severe narrowing. Electrocardiograms showed ST elevations and subsequent T-wave inversions. Despite the increased risk of cardiomyopathy due to the coronary anomaly, the patient required chemotherapy for life-threatening tumor lysis syndrome and refractory lactic acidosis. Anthracycline-based chemotherapy was initiated, and a follow-up echocardiogram after six months showed no acute changes. Conclusion: Managing cancer patients receiving anthracycline chemotherapy remains challenging due to limited guidelines. Anthracycline-induced cardiotoxicity is a concern, especially in patients with pre-existing cardiac anomalies like the malignant inter-arterial course of the right coronary artery. This case emphasizes the importance of recognizing and managing such anomalies in cancer patients to reduce the risk of sudden cardiac death. The higher mortality risk in cancer patients with coronary artery disease highlights the need for guidelines in managing anomalous coronary vessels in cancer patients. Further research is necessary to develop evidence-based strategies for managing cardiac complications in cancer patients, particularly those with pre-existing cardiac anomalies. Citation Format: Aliya M. Khan, Sophia Navajas Urisote, Danish A. Sheikh. Challenges in managing cancer patients with congenital coronary artery anomalies: A case report [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B043.

Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries.

Asymmetry of the aortic valve leaflets has been known since Leonardo Da Vinci, but the relationship between size and shape and origin of the coronary arteries has never been examined. Our aim was to evaluate this anatomy in a population of pediatric patients using a cross-sectional study design. Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study. Exclusion criteria: (I) bicuspid aortic valve; (II) aortic valve stenosis; (III) hypoplasia of aortic valve annulus, or aortic root; (IV) truncal valve; (V) coronary artery atresia; (VI) previous surgery on aortic valve and/or coronary arteries. In pre-operative TTE and intra-operative TEE inter-commissural distance and length of aortic valve leaflets were measured in short axis view in the isovolumic phase of systole. Echocardiography investigations, anonymized and randomly coded, were independently reviewed by at least two readers. Echocardiography, angiography, cardiac computed tomography (CT) scan and magnetic resonance imaging (MRI), and operative notes were reviewed to identify origin of coronary arteries. Two hundred sixty-one pediatric patients were identified, 93 excluded per our criteria, leaving 168 patients, age 2.6±4.3 years, weight 12.87±17.34 kg, 128 (76%) with normal and 40 (24%) with abnormal coronary arteries. In TTE and TEE measurements the non-coronary leaflet had larger area (P<0.001), while the right and left had equal areas, but different shape, with the left leaflet longer (P<0.001) and narrower (P=0.005) than the right. With the major source of blood flow from the right coronary sinus, the non-coronary leaflet was still the longest. However, there was no statically significant difference between the size and shape previously observed between the right and left leaflets. Our study showed asymmetry of size and shape among aortic valve leaflets, and a relationship with coronary artery origin. The complex aortic root anatomy must be approximated to optimize function of any surgical repair. These findings also may prove useful in the pre-operative definition of coronary artery anatomy and in the recognition of coronary artery anomalies.

Coexistence of Ehlers–Danlos Syndrome with Coronary–Pulmonary Arterial Fistula and Other Multiple Coronary Artery Anomalies

This case report presents a 34-year-old male with Ehlers–Danlos syndrome, type 2 diabetes mellitus, aortic valve regurgitation, and aortic bulb aneurysm. Following spine surgery for thoracic–lumbar stabilization, the patient underwent assessment for aortic bulb aneurysm and aortic valve replacement surgeries. Five months post spinal surgery, a coronary computed tomography angiography was performed. The coronary computed tomography angiography revealed unique findings, including the absence of the left main coronary artery, right coronary artery dominance, ectopic origin of the left circumflex artery from the right sinus of the valsalva, a coronary–pulmonary arterial fistula originating from the right sinus of the valsalva, and an additional right pulmonary vein. The patient was qualified for surgical treatment for an aortic bulb aneurysm, was informed about the high surgical risk, and is awaiting surgery. This case underscores the rarity of Ehlers–Danlos syndrome coexisting with multiple coronary artery anomalies. The presence of a coronary–pulmonary arterial fistula further emphasizes the need for specialized patient monitoring when Ehlers–Danlos syndrome and coronary anomalies converge.

Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study.

Understanding the incidence, causes, and trends of sudden cardiac death (SCD) among young competitive athletes is critical to inform preventive policies. This study included National Collegiate Athletic Association athlete deaths during a 20-year time frame (July 1, 2002, through June 30, 2022). Athlete deaths were identified through 4 separate independent databases and search strategies (National Collegiate Athletic Association resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database, and insurance claims). Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD. A total of 143 SCD cases in National Collegiate Athletic Association athletes were identified from 1102 total deaths. The National Collegiate Athletic Association resolutions list identified 117 of 143 (82%), the Parent Heart Watch database or media reports identified 89 of 143 (62%), the National Center for Catastrophic Sports Injury Research database identified 63 of 143 (44%), and insurance claims identified 27 of 143 (19%) SCD cases. The overall incidence of SCD was 1:63 682 athlete-years (95% CI, 1:54 065-1:75 010). Incidence was higher in male athletes than in female athletes (1:43 348 [95% CI, 1:36 228-1:51 867] versus 1:164 504 [95% CI, 1:110 552-1:244 787] athlete-years, respectively) and Black athletes compared with White athletes (1:26 704 [1:20 417-1:34 925] versus 1:74 581 [1:60 247-1:92 326] athlete-years, respectively). The highest incidence of SCD was among Division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). The incidence rate for SCD decreased over the study period (5-year incidence rate ratio, 0.71 [95% CI, 0.61-0.82]), whereas the rate of noncardiovascular deaths remained stable (5-year incidence rate ratio, 0.98 [95% CI, 0.94-1.04]). Autopsy-negative sudden unexplained death (19.5%) was the most common postmortem examination finding, followed by idiopathic left ventricular hypertrophy or possible cardiomyopathy (16.9%) and hypertrophic cardiomyopathy (12.7%), in cases with enough information for adjudication (118 of 143). Eight cases of death were attributable to myocarditis over the study period (1 case from January 1, 2020, through June 30, 2022), with none attributed to COVID-19 infection. SCD events were exertional in 50% of cases. Exertional SCD was more common among those with coronary artery anomalies (100%) and arrhythmogenic cardiomyopathy (83%). The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.

Impact of myocardial bridge defined by computed tomographic coronary angiography on fractional flow reserve after elective percutaneous coronary intervention

Abstract Background Myocardial bridge (MB) is a common anomaly of epicardial coronary artery that courses through myocardium. MB can be identified by computed tomographic coronary angiography (CTCA) or invasive coronary angiography (ICA). However, its relevance to coronary physiological parameters remains unknown. Purpose This observational study aimed to explore how MBs affect physiological parameters in patients with chronic coronary syndrome before and after revascularization. Methods We investigated 172 consecutive patients who underwent preprocedural CTCA and elective fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) in left anterior descending artery (LAD). We compared patient characteristics, angiographic, and pre- and post-PCI physiological parameters in patients with versus without MB. Results We identified MB in 70 (40.7%) and 23 (13.3%) patients by CTCA and ICA, respectively. CTCA detected the presence of MB with a sensitivity of 100% and a specificity of 33% when ICA-defined MB was regarded as a reference standard. Longer MB (adjusted odds ratio 1.18 [95% confidence interval 1.05-1.33], P &amp;lt; 0.01) and smaller left ventricular myocardial mass volume in whole LAD territory (adjusted odds ratio 0.93 [95% confidence interval 0.89-0.98], P&amp;lt;0.01) were associated with ICA detectability of MB. Older age and higher frequency of diabetes mellitus were observed in patients with MB compared with those without MB. Pre-PCI FFR values were not associated with a presence of MB regardless of either CTCA- or ICA-defined MB. On the other hand, post-PCI FFR values were significantly lower in patients with versus without MB by CTCA (0.82 [0.80-0.86] vs. 0.86 [0.82-0.89], P&amp;lt;0.01), while no significant difference was observed in post-PCI FFR between patients with and without ICA-defined MB (0.82 [0.81-0.84 vs. 0.84 [0.80-0.88], P=0.08). Multivariable linear regression analysis revealed that a presence of CTCA-defined long MB (≥25mm) (adjusted β coefficient = -0.040, P&amp;lt;0.01) and greater myocardial mass volume in whole LAD territory (adjusted β coefficient = -0.0004, P&amp;lt;0.01) were independently associated with lower post-PCI FFR. Conclusion A presence of MB was an independent predictor of lower post-PCI FFR after successful and elective PCI for LAD.

Syncopes in adolescents in sport

The study analyzes current data on syncope in children and adolescents. The study presents the classification of syncope and briefly describes the clinical manifestations of neurally mediated syncope and the main methods of its diagnosis and treatment. Syncopes associated with organic cardiac pathologies and primary cardiac arrhythmias are caused by hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, coronary artery anomalies, primary long QT syndrome, WolffParkinsonWhite syndrome, and bradyarrhythmias. The diagnostic features of syncope in children and young athletes and modern approaches to treatment and prevention are discussed.&#x0D; Although most syncopes in athletes are not associated with physical activity and have a neurotransmitter genesis, a thorough medical examination is needed. Factors that induce the development of syncopes in athletes must be identified. A prerequisite for admission to sports is the exclusion of the cardiac and arrhythmogenic reasons of syncopes. The decision to expand the sports regime should be made only after a thorough collection of medical history, including family history, and a comprehensive examination. In addition, the degree of risk in view of injuries, provocation, or fatal events following the loss of consciousness during sports must be estimated. This is extremely relevant for sports such as swimming, complex coordination sports (gymnastics and acrobatics), auto and motor sports, and alpine skiing.&#x0D; Although syncopes are common problems in pediatric practice, with only a few cases with cardiac causes based on structural or primary electrical myocardial diseases, they pose the greatest danger in sports medicine. Thus, such conditions must be excluded in young athletes because sports load can aggravate cardiac pathologies, which cause syncopes, due to untimely diagnosis before the start of a sports career.

Abstract 17997: Contemporary Trends in Coronary Artery Anomalies

Introduction: Coronary artery anomalies (CAA) are a group of congenital conditions whose prognostic significance is still widely debated. In part, this is due to the limited data on CAA, given its general incidental nature. Data on age, gender, and ethnic disparities is even more scarce. Hypothesis: There is an increase in prevalence of CAA over time with unchanged difference in mortality. Methods: The National Inpatient Sample (NIS) database was queried between 2016-2019 to identify hospitalizations with CAA. The primary outcome was in-hospital mortality. Secondary outcomes included type of hospital, region, age, and complications. Linear regression and Chi-squared were used for analysis. Results: Our study identified 7,821 patients diagnosed with CAA. There was a significant increase in the prevalence of CAA from 1,961 in 2016 to 2,127 in 2019 (p&lt;0.001). However, no significant difference in mortality rate (1.89% to 2.05%) in this time period was identified. The average age of the population diagnosed with CAA was 50.4 years, which was not significantly different between the study time periods. Comparing races, 62.35% of those with coronary anomalies were white, 17.54% were African American, 12.1% were Hispanic, and 3.11% were Asians or Pacific Islanders. Of note, 4.14% of those with CAA were diagnosed in a rural hospital, 14.68% in an urban non-teaching hospital, and 81.18% in a teaching hospital. This is a significant difference compared to the percentage composition of each hospital within the database. Conclusions: With recent advances in imaging technology, CAA has been detected at earlier stages, allowing for early intervention. However, our study suggests that CAA may still be under diagnosed, given that most were diagnosed at resource heavy teaching hospitals. In addition, the number of minorities diagnosed with CAA increased during the study period, suggesting disparities that exist and will continue to be addressed as access to modern medicine improves. Despite having a low mortality rate, the mortality rate did not improve over the study period. This highlights the need for further studies to identify challenges in diagnosis and management of CAA, especially regarding ethnic and racial disparities.

Abstract 13427: Incidence and Causes of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-year Study

Background: The incidence and causes of sudden cardiac death (SCD) among young competitive athletes impact prevention strategies yet remain incompletely understood. Methods: National Collegiate Athletic Association (NCAA) athlete deaths from 7/1/2002-6/30/2022 were identified through 4 independent databases/search strategies. Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD. Poisson regression was used to calculate incidence rate ratios (IRR) for 5-year intervals over the 20-year study. Results: A total of 143 SCD cases were identified among 1102 athlete deaths and 9,106,516 athlete-years (AYs). The incidence of SCD among NCAA athletes was 1:63,682 AYs [95% CI 1:54,065, 1:75,010]. Incidence was higher in males compared to females (1:43,348 vs. 1:164,504 AYs) and Black compared to White athletes (1:27,217 vs. 1:74,581 AYs). The highest incidence of SCD was among Division 1 male basketball players (1:8,188; White 1:5,848; Black 1:7,696 AYs). The incidence rate for SCD decreased over the study period (5-year IRR 0.71 [95% CI 0.61,0.82]), whereas the rate of non-cardiovascular deaths remained stable (5-year IRR 0.98 [95% CI 0.94,1.04]; Figure 1A ). Autopsy-negative sudden unexplained death (AN-SUD, 19.5%) was the most common post-mortem exam finding, followed by idiopathic left ventricular hypertrophy/possible cardiomyopathy (CM, 16.9%) and hypertrophic CM (12.7%) in cases with enough information for adjudication (118/143, Figure 1B ). There were 8 cases of myocarditis, with none attributed to COVID-19 infection. SCD events occurred most commonly during exertion among athletes with coronary artery anomalies (100%) and arrhythmogenic CM (83%), whereas AN-SUD and hypertrophic CM had a higher proportion of non-exertional SCD (44% and 40%, respectively). Conclusions: The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.

Surgical strategies and outcomes for myocardial bridges coexisting with other cardiac conditions

BackgroundMyocardial bridges are congenital coronary artery anomalies. There are still many controversies surrounding surgical treatment strategies for myocardial bridges combined with other heart disorders. The purpose of this study was to evaluate the surgical treatment strategies and outcomes in patients with these conditions.MethodsBetween March 2004 and October 2021, our institution witnessed 77 patients diagnosed with myocardial bridging who underwent surgical intervention. According to the myocardial bridge and combined heart disorder, four groups were identified: 1. isolated LAD supra-arterial myotomy group, 2. LAD CABG and(or not) myotomy group, 3. LAD supra-arterial myotomy and grafting of other branches group, and 4. LAD supra-arterial myotomy and other cardiac surgery group. The perioperative outcomes, symptoms, life quality, mortality, and major adverse cardiac events (MACEs) were analyzed.ResultsThere were no deaths during hospitalization and no rethoractomy for postoperative bleeding or major adverse cardiac events (MACEs). The follow-up period ranged from 2 months to 199.2 months (55.61 ± 10.21) months, the 10-year cumulative survival rates for the four groups of patients were 95.0%, 100%, 100% and 74.1%, and the 10-year freedom rates from the MACEs were 83.9%, 92.0%, 87.5% and 76.2%, respectively.ConclusionsSupra-arterial myotomy is preferred in patients with isolated myocardial bridge, and acceptable results can be achieved by choosing supra-arterial myotomy in combination with CABG or other cardiac surgery simultaneously for patients with myocardial bridges and other heart disorders.

Narrative Review of Anomalous Origin of Coronary Arteries: Pathophysiology, Management, and Treatment.

Coronary artery anomalies (CAA) are a diverse group of congenital anomalies and are the second most common cause of sudden cardiac death in the young population after Hypertrophic Cardiomyopathy (HCM). Symptoms range from chest pain, syncope, or sudden cardiac arrest to completely asymptomatic. The prevalence of congenital coronary artery anomalies in the general population is estimated to be between 1% and 2%. CAA often gets underdiagnosed due to the lack of knowledge of the disease process. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic coronary artery disease or luminal narrowing due to other causes. Congenital coronary artery anomalies account for 50-60% of this 5% of patients. Most patients are asymptomatic for most of their lives, and chest pain is the most common symptom in symptomatic patients when referred for coronary angiography, typically when the diagnosis is typically made. The malignant coronary artery is a rare presentation of a coronary anomaly when associated with atherosclerotic coronary artery disease or valvular heart disease. Patients with symptoms of an abnormal coronary artery origin will receive medical treatment/observation, exercise restriction, coronary angioplasty with stent deployment, or surgical repair.

Late follow-up of neo-aortic dimensions and coronary arteries in adult patients after the arterial switch operation

BackgroundAfter the arterial switch operation (ASO) for transposition of the great arteries (TGA), neo-aortic dilatation and coronary arterial anomalies, especially an interarterial course and acute coronary artery take-off angle, are commonly found. Long-term follow-up data after ASO is scarce. Aim of this study was to determine the prevalence of neo-aortic dilatation and coronary abnormalities, with special emphasis on acute coronary take-off angle, in adult TGA-ASO patients. MethodsIn this retrospective cohort study, all adult TGA-ASO patients with ≥1 CT-angiography (CTA) at the age of ≥16 years were included. ResultsEighty-one patients, 69 % male and median age 21.0 [18.5–22.8] years, were included. At baseline, maximum neo-aortic diameter was 39.2 ± 5.3 mm; 35 (43 %) patients had neo-aortic dilatation (neo-aortic diameter of >40 mm), 22 (27 %) patients had an acute coronary take-off angle (<30°), and 5 (6 %) patients had an interarterial course of the RCA (2 %) or LCA (4 %). Neo-aortic or coronary artery re-intervention occurred in 10 (12 %) patients. All 10 patients had neo-aortic dilatation or coronary take-off angle of <30° on baseline CTA. ConclusionThis study reports a prevalence of 43 % of neo-aortic dilatation, 6 % of interarterial coronary course and 27 % for acute coronary take-off angle (<30°) at a median term of 21.0 years post ASO. All patients with a neo-aortic re-intervention or coronary artery re-intervention during follow-up had a maximum neo-aortic diameter of >40 mm or a coronary take-off angle of <30° at baseline CTA. This hypothesis generating study suggests that an active surveillance in patients with neo-aortic dilation and/or an acute angulation of < 30° post ASO might be considered and requires prospective evaluation.

In Memoriam: Paolo Angelini (1941-2023)-A Pioneer and World-Leading Expert in Coronary Artery Anomalies. A Tribute From the International Coronary Artery Anomalies Collaborative (ICAAC).

In Memoriam: Paolo Angelini (1941-2023)-A Pioneer and World-Leading Expert in Coronary Artery Anomalies. A Tribute From the International Coronary Artery Anomalies Collaborative (ICAAC).