Catheter-based anatomic and functional assessment of coronary arteries in anomalous aortic origin of a coronary artery, myocardial bridges and Kawasaki disease

Abstract

Most diagnostic testing in patients with anomalous aortic origins of coronary arteries, myocardial bridges, and coronary artery changes after Kawasaki disease are performed with the use of noninvasive techniques. In some cases, however, further diagnostic information is needed to guide the clinician in treating these patients. In such instances, cardiac catheterization with invasive anatomic and functional testing is an invaluable tool. Moreover, interventional treatment in the cardiac catheterization laboratory may be performed in a small subset of these patients. As the diagnosis of these conditions is now becoming more common, it is important for pediatric interventional cardiologists to be familiar with these techniques. In this article, the role of angiography, intravascular ultrasound, fractional flow reserve, and optical coherence tomography in these patients is reviewed.

Functional Coronary Artery Assessment: a Systematic Literature Review

“…In this section, we discuss the results based on the search strategy presented in the previous section. and usability of each kind of exam [41,59,60,63]. In all cases, they were compared with at least one of the gold standard techniques or with outcome.…”

“…Once deaths caused by coronary heart disease or nonfatal myocardial infarction was 3 times more frequent in patients with adverse plaque [77], obtain plaque characteristics are essential to the correct CAD evaluation [10,74]. For this mean, the OCT, CCTA [2], IVUS [60,63], and angiography [19] are suggested as good sources of information. Unfortunately, current guidelines lack protocols to obtain high quality exams and make them available for larger studies and validation [77].…”

Expression of CD40 Ligand on T Cells and Soluble CD40 Ligand in Children With Kawasaki Disease

“…sCD40L can interact with CD40 present on a variety of cells in the blood vessels leading to inflammation and an atherogenic potential 10–19 . It has been postulated that KD may have long-term cardiovascular sequelae even when there have been no overt CAA during acute stage 20–31 . Although there are several differences in the pathogenesis of KD vasculopathy and atherosclerotic heart disease, several studies have also shown that patients with KD have an increased risk of premature atherosclerosis as assessed using flow-mediated dilatation of brachial artery or carotid intima media thickness 19–33 .…”

Management and Anesthetic Considerations for Patients With Anomalous Aortic Origin of a Coronary Artery

“…Some advances in risk stratification have been made utilizing intravascular ultrasound, optical coherence tomography and fractional flow reserve measurements with provocative testing using either adenosine or dobutamine during cardiac catheterization. 48,49 The number of evaluated patients is currently small and larger scale studies are required to establish a consistent link between findings and outcomes. In addition, some approaches (intravascular ultrasound, for example) have equipment-related limitations in regards to their application in pediatric patients.…”