Features associated with myocardial ischemia in anomalous aortic origin of a coronary artery: A Congenital Heart Surgeons' Society study

Jegatheeswaran, Anusha; Devlin, Paul J.; McCrindle, Brian W.; Williams, William G.; Jacobs, Marshall L.; Blackstone, Eugene H.; DeCampli, William M.; Caldarone, Christopher A.; Gaynor, J. William; Kirklin, James K.; Lorber, Richard; Mery, Carlos M.; Louis, James D. St.; Molossi, Silvana

doi:10.1016/j.jtcvs.2019.02.122

Cited by 84 publications

(84 citation statements)

References 36 publications

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“…In addition to “interarterial courses”, some additional potential high-risk coronary artery abnormalities are typically demonstrated in patients with ischemia in ACAOS, including acute take-off angle [33] , intraseptal course [39] , intramural course and length, and orifice anomalies [40] etc., but no agreement has been reached concerning definite risk features. In our series, proximal narrowing exhibited a weak association with ischemic symptoms; this is in accordance with data in right-ACAOS patients from Opolski, et al’s [24] and Marano et al’s [41] .…”

Section: Discussionmentioning

confidence: 99%

Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study

Han

Diao

Huang

et al. 2020

IJC Heart & Vasculature

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Background Anomalous left coronary artery from the opposite sinus (left-ACAOS) is a rare congenital heart disease. While “interarterial course” is considered as the malignant anatomic feature for these patients, a number of patients with left-ACAOS, who don’t follow the above anatomic pattern, were reported with ischemic symptoms. Purpose This study aims to evaluate the anatomic characteristics of left-ACAOS and their clinical relevance. Methods The coronary computed tomography angiography (CCTA) data from 44 patients with 46 left-ACAOS vessels were retrospectively included. Patients were divided into 2 groups: those with ischemic symptoms (n = 19) and those without ischemic symptoms (n = 25). Baseline clinical characteristics were recorded and the follow-up was done by telephone. CCTA images were reviewed for anomalous coronary artery, take-off angle and level, ostia morphology and grading, proximal narrowing, anomalous course and atherosclerotic plaques. Results The prevalence of left-ACAOS was approximately 0.09% among 48, 719 consecutive patients referred for coronary CTA in our institution. Right sinus of Valsalva (RSV) was the most common origin (36/46, 78.26%). Left-ACAOS arising from right coronary artery (RCA) had narrower proximal segment (P = 0.014) and more prone to atherosclerosis (P = 0.040) than left-ACAOS arising from right sinus of Valsalva (RSV). Proximal narrowing severity (P < 0.001) and degree of maximal coronary stenosis (P = 0.034) of the anomalous left artery was higher in patients with ischemic symptoms than those without. Of note, no MACE was recorded during a mean follow-up of 43.4 ± 26.2 months. Conclusion Left-ACAOS arising from RCA seems to be more prone to atherosclerosis than other subtypes. Proximal narrowing was more severe in patients with ischemia symptoms, which may contribute to risk stratification and clinical management.

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Section: Discussionmentioning

confidence: 99%

Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study

Han

Diao

Huang

et al. 2020

IJC Heart & Vasculature

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“…Anomalous left coronary artery, and to a lesser extent, anomalous right coronary artery are recognized causes of myocardial ischemia and sudden death, particularly in the presence of an intramural or interarterial coronary course [103]. The patient with Marfan syndrome presenting with chest pain or loss of consciousness, invokes concern for aortic dissection or ventricular arrhythmias [55] and the potential for ischemic coronary artery disease may be overlooked particularly in the absence of acquired risk factors.…”

Section: Anomalous Coronary Arteriesmentioning

confidence: 99%

Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease

Kodolitsch

Demolder

Girdauskas

et al. 2019

Expert Review of Cardiovascular Therapy

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Introduction: The revised Ghent nosology presents the classical features of Marfan syndrome. However, behind its familiar face, Marfan syndrome hides less well-known features. Areas covered: The German Marfan Organization listed unusual symptoms and clinical experts reviewed the literature on clinical features of Marfan syndrome not listed in the Ghent nosology. Thereby we identified the following features: (1) bicuspid aortic valve, mitral valve prolapse, pulmonary valve prolapse, tricuspid valve prolapse, (2) heart failure and cardiomyopathy, (3) supraventricular arrhythmia, ventricular arrhythmia, and abnormal repolarization, (4) spontaneous coronary artery dissection, anomalous coronary arteries, and atherosclerotic coronary artery disease, tortuosity-, aneurysm-, and dissection of large and medium-sized arteries, (5) restrictive lung disease, parenchymal lung disease, and airway disorders, (6) obstructive-and central sleep apnea, (7) liver and kidney cysts, biliary tract disease, diaphragmatic hernia, and adiposity, (8) premature labor, and urinary incontinence, (9) myopathy, reduced bone mineral density, and craniofacial manifestations, (10) atrophic scars, (11) caries, and craniomandibular dysfunction, (12) headache from migraine and spontaneous cerebrospinal fluid leakage, (13) cognitive dysfunction, schizophrenia, depression, fatigue, and pain, (14) and activated fibrinolysis, thrombin, platelets, acquired von Willebrand disease, and platelet dysfunction. Expert commentary: Future research, nosologies, and guidelines may consider less well-known features of Marfan syndrome. ARTICLE HISTORY

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“…Besides, the pathophysiological correlation between CA and coronary artery events is still not clear, corresponding to an epidemiological description. 10,11 The objective of the study was to study the most common anatomical anomalies observed during cardiac catheterization procedures.…”

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confidence: 99%

Most common anatomic anomalies of coronary arteries

Roman¹,

Silva²,

Santos³

et al. 2020

J Transcat Intervent

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Background: Coronary artery anomalies represent an array of malformations of the vessels responsible for myocardial perfusion, with a prevalence of 1% in the general population. Mostly asymptomatic, they are diagnosed during routine tests. When symptomatic, they are the second major cause of sudden death in young athletes. Our study aimed to assess the most commonly found coronary vessel anatomic anomalies during cardiac catheterization procedures. Methods: An analytic cross-sectional study was performed assessing the medical charts of patients submitted to cardiac catheterization during the second semester of 2018. A total of 782 medical charts were analyzed, representing all patients submitted to cardiac catheterization. We performed an epidemiological description of the sample that comprised the following parameters: age, sex, dominance pattern, presence/absence of anomaly and anomaly classification. Results: From the charts analyzed, 86 (10.99%) showed anomalies. Fifty-one patients (59.3%) were male and the most frequent anomaly was myocardial bridging of left anterior descending coronary artery, found in 66 patients (88.37% of total anomalies). Conclusion: We found a two-fold anomaly prevalence when comparing to data reported in previous studies. Corroborating most studies, we found myocardial bridging of the left anterior descending coronary artery as the most frequent anomaly. RESUMO -Introdução:As anomalias coronarianas correspondem a um grupo de malformações nos vasos sanguíneos responsáveis pela irrigação miocárdica, com prevalência de cerca de 1%, cada uma, com relação à população geral. Grande parte é assintomática, tendo diagnóstico a partir de achados em exames casuais. Quando são apresentados sintomas, é a segunda maior causa de morte súbita em jovens atletas. O objetivo deste estudo foi investigar as alterações anatômicas coronarianas mais frequentes em procedimentos de cateterismo cardíaco. Métodos: Realizamos um estudo transversal analítico, por meio da avaliação de prontuários de pacientes submetidos a cateterismo cardíaco durante o segundo semestre de 2018. No total, foram avaliados 782 prontuários, sendo incluídos todos os pacientes que passaram por cateterismo cardíaco. Elaboramos o perfil epidemiológico, diferenciando os seguintes dados: idade, sexo, padrão de dominância, presença/ausência de anomalia e tipo. Resultados: Dos prontuários analisados, 86 (10,99%) apresentavam alguma anomalia. Eram do sexo masculino 51 pacientes (59,3%), e a anomalia mais frequente foi o trajeto intramiocárdico da artéria descendente anterior, em um total de 66 pacientes (88,37% do total de anomalias). Conclusão: Foi encontrado aproximadamente o dobro das prevalências relatadas em outros estudos. O trajeto intramiocárdico de artéria descendente anterior foi a anomalia mais encontrada, concordando com a maioria dos estudos. Descritores: Anomalias dos vasos coronários; Angiografia coronária; Cateterismo cardíaco BACKGROUNDCongenital coronary artery anomalies occur when the origin of the coronary at the aorta is n...

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Features associated with myocardial ischemia in anomalous aortic origin of a coronary artery: A Congenital Heart Surgeons' Society study

Cited by 84 publications

References 36 publications

Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study

Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study

Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease

Most common anatomic anomalies of coronary arteries

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