Silvana Molossi1, Hitesh Agrawal2, Carlos M Mery3, Rajesh Krishnamurthy4, Prakash Masand1,5, S Kristen Sexson Tejtel1, Cory V Noel6, Athar M Qureshi1, Siddharth P Jadhav1,5, E Dean McKenzie1,7, Charles D Fraser3. 1. Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children's Hospital, Baylor College of Medicine, Houston. 2. Invasive Cardiac Imaging and Interventional Catheterization Laboratory, Le Bonheur Children's Hospital, The University of Tennessee Health Sciences Center, Memphis (H.A.). 3. Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin (C.M.M., C.D.F.). 4. Division of Pediatric Radiology, Nationwide Children's Hospital, Columbus, OH (R.K.). 5. Section of Pediatric Radiology (P.M., S.P.J.), Texas Children's Hospital, Baylor College of Medicine, Houston. 6. Seattle Children's Pediatric Cardiology of Alaska, Seattle Children's Hospital, Anchorage (C.V.N.). 7. Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery (E.D.M.), Texas Children's Hospital, Baylor College of Medicine, Houston.
Abstract
BACKGROUND: Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm. METHODS: Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy-anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium-and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk. RESULTS: Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7-2.8) years. CONCLUSIONS: In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.
BACKGROUND:Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm. METHODS:Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy-anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium-and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk. RESULTS: Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7-2.8) years. CONCLUSIONS: In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.
Authors: Claire J Koppel; Diederick B H Verheijen; Philippine Kiès; Anastasia D Egorova; Hildo J Lamb; Michiel Voskuil; J Wouter Jukema; Dave R Koolbergen; Mark G Hazekamp; Martin J Schalij; Monique R M Jongbloed; Hubert W Vliegen Journal: Eur Heart J Open Date: 2022-05-02
Authors: Marius Reto Bigler; Afreed Ashraf; Christian Seiler; Fabien Praz; Yasushi Ueki; Stephan Windecker; Alexander Kadner; Lorenz Räber; Christoph Gräni Journal: Front Cardiovasc Med Date: 2021-01-21
Authors: Tom Kai Ming Wang; Tiffany Dong; Paul C Cremer; Hani Najm; Gosta Pettersson; Wael A Jaber Journal: J Nucl Cardiol Date: 2022-08-17 Impact factor: 3.872