Michael X Jiang1, Eugene H Blackstone2, Tara Karamlou3, Joanna Ghobrial4, Ellen K Brinza1, Michael J Haupt1, Gosta B Pettersson3, Jeevanantham Rajeswaran5, William G Williams6, Elizabeth V Saarel7. 1. Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio. 2. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 3. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 4. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. 5. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 6. Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada. 7. Department of Pediatric Cardiology, St. Luke's Health System, Boise, Idaho. Electronic address: saarele@slhs.org.
Abstract
BACKGROUND: Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden death in youth. However, its significance and optimal management in adults is poorly understood. Our objective is to characterize AAOCA in a large single-center adult cohort based on coronary anatomic variants and surgical management strategies. METHODS: We reviewed imaging, clinic, and operative reports for 645 adults with an encounter diagnosis code of congenital coronary anomaly from July 2015 to July 2017. After excluding other congenital heart defects, we characterized 167 patients with AAOCAs by anatomic variant, symptoms at diagnosis, indication for advanced imaging, and if performed, surgical repair. To describe the anatomic variant, we classified the origin and course by following the atomization scheme developed by the Congenital Heart Surgeon's Society's AAOCA registry. RESULTS: Among adults with AAOCA, the anomalous origin involved the right coronary artery in 57% (96 of 167), left main coronary artery in 23% (39 of 167), left anterior descending in 2% (4 of 167), circumflex in 16% (26 of 167), and multiple coronaries in 1% (2 of 167). Anomalous right coronary arteries were diagnosed at an older median age than anomalous left main coronary arteries (55 vs 51 years, respectively; P = .026). Surgical repair of AAOCA occurred in 22% (36 of 167) of patients. Concomitant cardiac surgical procedures accompanied 36% (13 of 36) of them. No deaths occurred over a median follow-up of 2.5 years. CONCLUSIONS: Most patients in our single-center AAOCA registry were diagnosed in the presence of cardiac symptoms. Concomitant aortic valve disease and coronary atherosclerotic burden complicate both the evaluation and surgical approach to adult AAOCA repair.
BACKGROUND: Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden death in youth. However, its significance and optimal management in adults is poorly understood. Our objective is to characterize AAOCA in a large single-center adult cohort based on coronary anatomic variants and surgical management strategies. METHODS: We reviewed imaging, clinic, and operative reports for 645 adults with an encounter diagnosis code of congenital coronary anomaly from July 2015 to July 2017. After excluding other congenital heart defects, we characterized 167 patients with AAOCAs by anatomic variant, symptoms at diagnosis, indication for advanced imaging, and if performed, surgical repair. To describe the anatomic variant, we classified the origin and course by following the atomization scheme developed by the Congenital Heart Surgeon's Society's AAOCA registry. RESULTS: Among adults with AAOCA, the anomalous origin involved the right coronary artery in 57% (96 of 167), left main coronary artery in 23% (39 of 167), left anterior descending in 2% (4 of 167), circumflex in 16% (26 of 167), and multiple coronaries in 1% (2 of 167). Anomalous right coronary arteries were diagnosed at an older median age than anomalous left main coronary arteries (55 vs 51 years, respectively; P = .026). Surgical repair of AAOCA occurred in 22% (36 of 167) of patients. Concomitant cardiac surgical procedures accompanied 36% (13 of 36) of them. No deaths occurred over a median follow-up of 2.5 years. CONCLUSIONS: Most patients in our single-center AAOCA registry were diagnosed in the presence of cardiac symptoms. Concomitant aortic valve disease and coronary atherosclerotic burden complicate both the evaluation and surgical approach to adult AAOCA repair.
Authors: Michael X Jiang; Muhammad O Khan; Joanna Ghobrial; Ian S Rogers; Gosta B Pettersson; Eugene H Blackstone; Alison L Marsden Journal: JTCVS Tech Date: 2022-02-25
Authors: Michael X Jiang; Ellen K Brinza; Joanna Ghobrial; Dominique L Tucker; Sohini Gupta; Jeevanantham Rajeswaran; Tara Karamlou Journal: JTCVS Open Date: 2022-04-20