Surgical management of anomalous coronary arteries

Ong, Chin Siang; Cameron, Duke E.; Jacobs, Marshall L.

doi:10.21037/acs.2018.08.02

Cited by 22 publications

(8 citation statements)

References 35 publications

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“…All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgical repair when surgery was applicable due to high-risk anatomy, 14 while 20 underwent conservative medical treatment, following currently available guidelines. 15 Regarding the surgery techniques, the majority underwent coronary unroofing (n=22/27); three patients experienced coronary reimplantation, one patient a lateral coronary translocation and one the Vouhé’s osteoplasty.…”

Section: Resultsmentioning

confidence: 99%

Echocardiographic screening for the anomalous aortic origin of coronary arteries

et al. 2021

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AimsWe sought to determine the diagnostic performance, clinical profiles and outcomes of anomalous aortic origin of coronary arteries (AAOCA) using a standardised echocardiographic approach in young adults and athletes.MethodsIn 2015–2019, we screened 5998 outpatients (age 16 years (Q1–Q3: 11, 36)), referred for routine echocardiography, using four specific echocardiographic windows: parasternal short/long axis and apical 4/5-chambers view. Coronary CT confirmed AAOCA. For the performance analysis, 300 coronary-CT scans were available; two independent and double-blinded physicians retrospectively reviewed echocardiographic images.ResultsA total of 47 AAOCA was diagnosed; the overall prevalence was 0.0078%. Over 5 years, we found a significant increment of AAOCA diagnostic rate (P for trend=0.002). Syncope (n=17/47) and palpitations (n=6/47) were prevalent symptoms. All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgery, while 20 underwent a conservative medical treatment. All patients are alive at a median follow-up of 3±1.6 years; only surgical repairs restarted their activity. Our method showed better sensitivity than traditional short-axis evaluation: 93% vs 83%, p=0.0030 (AUC 0.96 (95% CI 0.92, 0.99) and AUC 0.89 (95% CI 0.83, 0.95), respectively), with a good interobserver agreement (95%, k=0.83, p<0.001).ConclusionsThe application of a standardised echocardiographic approach for AAOCA detection led to a significantly increased rate of identified anomalies. This approach demonstrated higher sensitivity than the traditional echocardiographic assessment. Implementing this protocol in clinical practice may help improve the AAOCA diagnosis in young adults and athletes.Trial registration numberNCT04224090.

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Section: Resultsmentioning

confidence: 99%

Echocardiographic screening for the anomalous aortic origin of coronary arteries

et al. 2021

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“…However, the management of asymptomatic patients with an AAOCA is not as clearly defined. Currently, there is a class IIb recommendation for repairing an asymptomatic anomalous right or left coronary artery from the contralateral coronary sinus that follows an intraarterial course [ 11 , 12 ]. Surgical correction of a left coronary artery from the right sinus is more strongly considered due to an increased risk of SCD [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Anomalous Origin of the Right Coronary Artery From the Left Coronary Cusp Presenting as a Non-ST-Elevation Myocardial Infarction (NSTEMI)

Malik¹,

Seibolt²

2022

Cureus

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Coronary artery anomalies are relatively uncommon in the general population with a roughly 1% incidence. Though oftentimes asymptomatic, these anomalies can be detrimental, resulting in myocardial infarction and even sudden cardiac death. Here, we present a case in which a 65-year-old male presented to the emergency room with substernal chest pain that radiated into his left arm. The patient's cardiac enzyme panel revealed a troponin of 10.14 ng/mL and a creatine kinase-myocardial band (CK-MB) of 78.8 ng/mL. Furthermore, the patient's electrocardiogram demonstrated normal sinus rhythm with no significant changes. Upon cardiac catheterization, his right coronary artery was found to originate from the left coronary cusp. Moreover, the anomalous artery demonstrated significant stenosis in its middle portion, which was presumably causing his elevated cardiac enzymes and anginal chest pain. The patient underwent successful percutaneous coronary intervention and was discharged the following day.

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“…Invasive interventions including PCI with stent placement and surgical intervention are preserved for symptomatic patients and patients with a malignant course of the anomalous artery [30, 31]. Surgical interventions include reimplantation of the anomalous artery to the aorta, osteoplasty, coronary artery bypass grafting (CABG) of the anomalous artery, and pulmonary artery translocation [32]. Two of our patients had signification coronary artery disease and underwent CABG.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Spectrum, and Outcomes of Single Coronary Artery Detected on Coronary Computed Tomography Angiography (CCTA)

Umairi

Al-khouri

2019

Radiology Research and Practice

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Background. Single coronary artery (SCA) is a rare congenital anomaly in which there is an isolated coronary artery that arises from a single coronary ostium and provides coronary blood supply to the entire myocardium. SCA is classified into different types based on the origin, branching pattern, and course. Although the majority of patients with SCA are asymptomatic, some patients can present with life-threatening symptoms. Aim. To examine the prevalence, anatomical distribution, and outcome of the single coronary artery anomaly detected on coronary computed tomography angiography (CCTA) in a single center in Oman. Methods. Retrospectively, we reviewed 4,445 patients who underwent coronary computed tomography angiography between September 2012 and August 2018 at the National Heart Center, Muscat, Oman. We identified patients with a single coronary artery, and we evaluated the origin, course, and outcome of SCA. Results. We found 12 patients with single coronary artery among 4,445 patients with a mean age of 56.4 years (age range: 34 to 71 years; male : female ratio: 5 : 7). The most common class was RIII-C seen in 4 patients. Other SCA included RII-C, RII-A, and RII-S, two in each class. One patient had RI and one had LII-P. Two patients had coronary artery bypass graft. No major adverse cardiac events were reported over a mean follow-up of 25.3 months. Conclusion. Single coronary artery (SCA) is a rare congenital anomaly classified into different types. In our study, the prevalence of SCA was 0.27% that is higher than the figures from previous reports.

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Surgical management of anomalous coronary arteries

Cited by 22 publications

References 35 publications

Echocardiographic screening for the anomalous aortic origin of coronary arteries

Echocardiographic screening for the anomalous aortic origin of coronary arteries

Anomalous Origin of the Right Coronary Artery From the Left Coronary Cusp Presenting as a Non-ST-Elevation Myocardial Infarction (NSTEMI)

Prevalence, Spectrum, and Outcomes of Single Coronary Artery Detected on Coronary Computed Tomography Angiography (CCTA)

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