Surgical unroofing of intramural anomalous aortic origin of a coronary artery in pediatric patients: Single-center perspective

Sachdeva, Shagun; Frommelt, Michele A.; Mitchell, Michael E.; Tweddell, James S.; Frommelt, Peter C.

doi:10.1016/j.jtcvs.2017.11.003

Cited by 42 publications

(26 citation statements)

References 48 publications

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“…As shown in several reports, resting ECG, even in symptomatic patients, does not show any typical alternations (8, [74][75][76]. Similarly, stress ECG, which has already a limited diagnostic accuracy for the diagnosis of CAD [sensitivity 68%, specificity 77% (77)], is not reliable for the detection of ACAOSdependent myocardial ischemia (8, 71,75,78,79). If stress ECG may play a role by reproducing symptoms or arrhythmia is unclear (80).…”

Section: Electrocardiogrammentioning

confidence: 99%

See 1 more Smart Citation

Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence

Bigler

Ashraf

Seiler

et al. 2021

Front. Cardiovasc. Med.

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Coronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). The interarterial variants (with the anomalous vessel situated between the great arteries) are historically called “malignant,” based on an anticipated higher risk for myocardial ischemia and sudden cardiac death (SCD), especially affecting young patients during strenuous physical activity. However, the interarterial course itself may not be the predominant cause of ischemia, but rather represents a surrogate for other ischemia-associated anatomical high-risk features. As the exact pathophysiology of ACAOS is not well-understood, there is a lack of evidence-based guidelines addressing optimal diagnostic work-up, downstream testing, sports counseling, and therapeutic options in patients with ACAOS. Therefore, treating physicians are often left with uncertainty regarding the clinical management of affected patients. This review focuses on the pathophysiologic consequences of ACAOS on myocardial ischemia and discusses the concept of the interplay between fixed and dynamic coronary stenosis. Further, we discuss the advantages and limitations of the different diagnostic modalities and give an outlook by highlighting the gaps of knowledge in the assessment of such anomalies.

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Section: Electrocardiogrammentioning

confidence: 99%

“…Up to 66% of diagnosed ACAOS patients do not report any symptoms (5) and the initial presentation may be sudden cardiac death (71). Thus, diagnostic evaluation should not only obtain evidence for ischemia (which can in turn induce arrhythmia), but also assess possible underlying arrhythmogenic myocardial fibrosis and scar.…”

Section: Substrate For Arrhythmiamentioning

confidence: 99%

Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence

Bigler

Ashraf

Seiler

et al. 2021

Front. Cardiovasc. Med.

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show abstract

“…TTE can prospectively identify AAORCA and AAOLCA, particularly when there is an interarterial course. 44 Moreover, TTE is often the screening tool used to identify this lesion because many children are asymptomatic, and the diagnosis is often made when TTE has been ordered for other reasons. The CA origins can frequently be imaged by TTE when good transthoracic parasternal windows are available.…”

Section: Isolated Congenital Coronary Anomaliesmentioning

confidence: 99%

Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography

Frommelt

Lopez

Dimas

et al. 2020

Journal of the American Society of Echocardiography

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“…Despite promising results, surgical intervention is not always completely successful. A recent study by Sachdeva et al 68 provides some insights into long-term outcomes and issues that warrant further investigation: The authors retrospectively analyzed a cohort of 63 patients with ARCA-L (79%)/ ALCA-R (21%) who underwent surgical unroofing of an intramural anomalous aortic origin of a coronary artery. There were no intraoperative or early deaths.…”

Section: Treatmentmentioning

confidence: 99%

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

Kloesel

Richtsfeld

Konia

et al. 2018

Semin Cardiothorac Vasc Anesth

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The term "coronary artery anomalies" encompasses a large and heterogeneous group of disorders that may affect origin, intrinsic anatomy, course, location, and termination of the coronary arteries. With these different anatomies, presentation, symptoms, and outcomes are heterogeneous as well. While significant efforts are directed toward improving diagnosis and risk-stratification, best evidence-guided practices remain in evolution. Data about anesthetic management of patients with coronary anomalies are lacking as well. This review aims to provide the anesthesiologist with a better understanding of an important subgroup of coronary artery anomalies: anomalous aortic origin of a coronary artery. We will discuss classification, pathophysiology, incidence, evaluation, management, and anesthetic implications of this potentially fatal disease group.

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Surgical unroofing of intramural anomalous aortic origin of a coronary artery in pediatric patients: Single-center perspective

Cited by 42 publications

References 48 publications

Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence

Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence

Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography

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

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