Current practices are variable in the evaluation and management of patients with anomalous aortic origin of a coronary artery: Results of a survey

Agrawal, Hitesh; Mery, Carlos M.; Day, P.; Tejtel, S. Kristen Sexson; McKenzie, E. Dean; Fraser, Charles D.; Qureshi, Athar M.; Molossi, Silvana

doi:10.1111/chd.12511

Cited by 17 publications

(11 citation statements)

References 18 publications

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“…4 The risk stratification of patients with AAOCA remains challenging because of the impact of anatomic variations, patient factors, 5,6 absence of symptoms in the majority of patients, and SCD representing a small proportion of this group, 7 leading to a wide variation in management of these patients between institutions. 8 Despite excellent surgical survival, symptoms and morbidity postoperatively after AAOCA repair, [9][10][11] and even major cardiac events such as SCD have been observed postoperatively. 12,13 An important outcome measure after this operation is the function of the aortic valve, and progressive aortic regurgitation remains an important indication for continued postoperative morbidity and need for reintervention.…”

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confidence: 99%

Complete unroofing of the intramural coronary artery for anomalous aortic origin of a coronary artery: The role of commissural resuspension?

Yerebakan

Öztürk

Mota

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: Although surgical repair of an anomalous aortic origin of the coronary artery has low operative mortality, longer-term risk of ischemia and aortic regurgitation remains concerning. We routinely perform aortic commissure resuspension after unroofing and sought to evaluate the outcomes with regard to aortic valve competence, symptoms, and signs of ischemia with this approach. Methods: Twenty-six consecutive patients who received the unroofing procedure for anomalous aortic origin of the coronary artery (10 left; 16 right) between 2004 and 2016 were reviewed. In addition to complete unroofing of the intramural coronary, patients early in the cohort (n ¼ 9) received unroofing only, and aortic commissural resuspension was performed routinely in the subsequent patients (n ¼ 17). Outcomes between commissural resuspension versus no commissural resuspension were compared. The occurrence of mild and greater aortic regurgitation was assessed using a time-to-event analysis after varying lengths of time. Commissural resuspension was considered as the predictor, and the groups were compared using a log-rank test. Results: There was no operative mortality. One patient in the no commissural resuspension group died 10 years later of prosthetic aortic valve endocarditis (aortic valve replacement 7 years after unroofing). The follow-up duration was 6.9 years (4.9-9.1) and 3.7 years (2.1-4.3) in the no commissural resuspension and commissural resuspension groups, respectively (P ¼ .001). Available postoperative exercise stress test data (n ¼ 14) revealed that 50% had an endurance level at the 25th percentile or greater for age. After a median follow-up of 1.9 years (3 months to 10.6 years), no patient in the commissural resuspension group had aortic regurgitation, whereas 6 of 9 patients (67%) in the no commissural resuspension group had stable but mild or greater aortic regurgitation. Time-to-event analysis with the primary event of occurrence of mild or greater aortic regurgitation showed significantly higher freedom from the occurrence of aortic regurgitation in the commissural resuspension group (P ¼ .035). Conclusions: Surgical repair of an anomalous aortic origin of the coronary artery can be performed with excellent early and midterm outcomes. Routine commissural resuspension of the aortic valve may lead to a lower rate of aortic valve regurgitation without increasing the risk of ischemia.

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confidence: 99%

Complete unroofing of the intramural coronary artery for anomalous aortic origin of a coronary artery: The role of commissural resuspension?

Yerebakan

Öztürk

Mota

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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“…CMR is the ideal tool to diagnose myocarditis and also to depict coronary artery anatomy. CCTA is, depending on the institution, the first line non-invasive imaging modality to depict in high spatial and temporal resolution the coronary artery anatomy (7). Unroofing is the procedure of choice to correct the intramural segment of AAOCA in young patients.…”

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confidence: 99%

Symptomatic Coronary Anomalies and Ischemia in Teenagers – Rare but Real

Borns

Gräni

Kadner

et al. 2020

Front. Cardiovasc. Med.

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Three cases of teenagers with anomalous aortic origin of the coronary arteries (AAOCA) are presented with typical exercise induced symptoms (chest pain, syncope or dizziness). Using multimodal imaging, diagnoses was confirmed showing interarterial and/or intramural course of the coronary artery explaining the ischemia induced symptoms. Successful surgical correction with unroofing of the AAOCA was performed in all three cases with a favorable outcome. Even though AAOCA are rare, some variants may be relevant and potentially life threatening, therefore treating physicians should be aware of correctly diagnosing and treating these individuals.

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“…In this case, the patient was scheduled for cardiac surgery with unroofing, or marsupialization, of the right coronary artery to prevent compression during its malignant course [15]. In all age groups, the management of patients with anomalous origin of the coronary arteries is highly variable, ranging from conservative management to surgical correction, possibly because this condition can present at any age [16-17]. The procedure of unroofing, or marsupialization of the coronary artery is a procedure that can be performed with minimal risk and usually results in good anatomic and functional outcome [15].…”

Section: Discussionmentioning

confidence: 99%

A Case of Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva with a Malignant Course

Gupta

Kumar

Gupta

et al. 2019

Cureus

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Congenital heart disease in adults, including congenital anomalies of the coronary arteries, can be asymptomatic and diagnosed incidentally, but they can also be a cause of sudden cardiac death. The recent guidelines on the management of adults with congenital heart disease from the American Heart Association (AHA) and the American College of Cardiologists (ACC) identify that an anomalous coronary artery origin can lead to myocardial ischemia, arrhythmias, or sudden cardiac death. When the course of the coronary artery runs between the aorta and pulmonary trunk, it is described as having a "malignant course." Emergency surgical correction is required to restore the normal anatomy of the aberrant coronary artery. This report is of a 57-year-old man with a history of hypertension who had a normal electrocardiogram (ECG). A nuclear exercise stress test showed a resting and exercise ejection fraction (EF) of 56% with transient ischemic dilatation (TID) of the left ventricle. Coronary artery computed tomography angiography (CTA) identified an anomalous right coronary artery (AORCA) originating from the left sinus of Valsalva and coursing between the aorta and pulmonary trunk. TID on nuclear imaging is usually associated with left ventricular hypertrophy, microvascular disease, or multivessel macrovascular disease and has not been previously described in AORCA.

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Current practices are variable in the evaluation and management of patients with anomalous aortic origin of a coronary artery: Results of a survey

Cited by 17 publications

References 18 publications

Complete unroofing of the intramural coronary artery for anomalous aortic origin of a coronary artery: The role of commissural resuspension?

Complete unroofing of the intramural coronary artery for anomalous aortic origin of a coronary artery: The role of commissural resuspension?

Symptomatic Coronary Anomalies and Ischemia in Teenagers – Rare but Real

A Case of Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva with a Malignant Course

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