Anomalous interarterial left coronary artery: An evidence based systematic overview

Moustafa, Sherif; Zehr, Kenton J.; Mookadam, Martina; Lorenz, Elizabeth C.; Mookadam, Farouk

doi:10.1016/j.ijcard.2007.04.086

Cited by 41 publications

(30 citation statements)

References 78 publications

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“…Follow-up investigation of the LMCA was scheduled for 4 weeks after the acute event. At this time, both CT angiography and subsequent intravascular ultrasound (Figure 2) demonstrated an asymmetrical slit-like orifice of the LMCA with cross-sectional area of 6.3 mm 2 .The stent was fully expanded in the LMCA midsection, with a cross-sectional area of 9.3 mm 2 . The morphology of the LMCA ostium as well as potential subsequent compression or restenosis of the stent within the interarterial segment were considered to jeopardize the patient's long-term prognosis.…”

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confidence: 88%

“…Both CT angiography (A and B) and a subsequent intravascular ultrasound study (C and D) demonstrate an extremely asymmetrical slit-like orifice of the LMCA with a cross-sectional area of 6.3 mm 2 and a fully expanded stent in the midsection with a cross-sectional area of 9.3 mm 2 .…”

Section: Figurementioning

confidence: 99%

“…1 Adverse outcome has been associated with a slit-like orifice and acute angulation. 2 In this case, CT angiography was instrumental in delineating the slit-like Figure 1. CT angiography demonstrates the anomalous origin of the LMCA (A) (arrow) with acute angulation and narrowing of its proximal segment, a patent stent in the midsegment (asterisk), and an interarterial course between the aorta and the pulmonary artery (PA) (B).…”

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Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest

Jaffe

Shiran

Gaspar

et al. 2009

Circ: Cardiovascular Imaging

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A 48-year-old woman was admitted with extensive anterior ST-elevation myocardial infarction and cardiac arrest on arrival. Emergent coronary angiography was performed simultaneously with cardiopulmonary resuscitation and multiple DC shocks for ventricular fibrillation. The right coronary artery was patent, but the origin of the left main coronary artery (LMCA) was not identified initially. After persistent efforts (2.5 hours), the LMCA origin was located at the right coronary sinus with a critical stenosis in its midportion. LMCA stenting was performed with a good angiographic result. The subsequent hospital course, which included prolonged mechanical ventilation and reversible anoxic brain injury, culminated in full hemodynamic and neurological recovery. Predischarge computed tomographic (CT) angiography (Figure 1) demonstrated the anomalous origin of the LMCA with acute angulation and asymmetry of its proximal segment, a patent stent in the midsegment, and an interarterial course between the aorta and the pulmonary artery. Cine CT demonstrated mildly reduced left ventricular contraction with anterior hypokinesis and subendocardial hypoenhancement, reflecting microvascular obstruction (see video in the online-only Data Supplement). Because the ostial LMCA narrowing was not severe and not perceived to be the culprit lesion and the patient was recovering from a major neurological insult, definitive corrective surgery was deferred and she was discharged to her home. Follow-up investigation of the LMCA was scheduled for 4 weeks after the acute event. At this time, both CT angiography and subsequent intravascular ultrasound (Figure 2) demonstrated an asymmetrical slit-like orifice of the LMCA with cross-sectional area of 6.3 mm 2 .The stent was fully expanded in the LMCA midsection, with a cross-sectional area of 9.3 mm 2 . The morphology of the LMCA ostium as well as potential subsequent compression or restenosis of the stent within the interarterial segment were considered to jeopardize the patient's long-term prognosis. She underwent successful coronary artery bypass surgery (left internal mammary to left anterior descending, right internal mammary to an obtuse marginal) and was discharged to her home.Anomalous LMCA origin with an interarterial course is a recognized risk factor for sudden cardiac death in young subjects. 1 Adverse outcome has been associated with a slit-like orifice and acute angulation. 2 In this case, CT angiography was instrumental in delineating the slit-like Figure 1. CT angiography demonstrates the anomalous origin of the LMCA (A) (arrow) with acute angulation and narrowing of its proximal segment, a patent stent in the midsegment (asterisk), and an interarterial course between the aorta and the pulmonary artery (PA) (B). RCA indicates right coronary artery; CX, circumflex artery; LAD, left anterior descending coronary artery.From the

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confidence: 88%

Section: Figurementioning

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Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest

Jaffe

Shiran

Gaspar

et al. 2009

Circ: Cardiovascular Imaging

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“…Unfortunately, one must maintain a high level suspicion with regard to the potential diagnosis of anomalous coronary artery as less than 50% of persons with anomalous origin the coronary artery from the opposing sinus of Valsalva describe symptoms prior to sudden death [26,27]. Symptoms may be related to the length of the intramural segment [28].…”

Section: Coronary Artery Anomaliesmentioning

confidence: 99%

Cardiac Arrest and Sudden Cardiac Death in the Pediatric Population

Baker‐Smith¹,

Vashist²

2012

J Clin Exp Cardiolog

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Sudden cardiac arrest in children is a rare event. However, sudden cardiac arrest of a child is a devastating event. Clinicians should be aware of conditions associated with sudden cardiac arrest in the pediatric population. This article reviews the most common causes of sudden cardiac arrest in the pediatric population. We review recommendations for screening and diagnosis. We also briefly discuss current management recommendations for the various causes of sudden cardiac arrest in the pediatric population.

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“…However slitlike ostial morphology has been associated with adverse outcome in subjects with this anomaly regardless of the measured crosssectional area. 1 The utility of fractional flow reserve in guiding therapy in this case is unclear because left main lesions were excluded from the FAME study, which is the primary source of outcome data for this technology. 2 We are aware of the risk of graft failure in vessels with non-flow-limiting stenosis; however, our surgical colleagues preferred not to occlude the left main artery at the time of surgery.…”

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confidence: 99%

Response to Letter by Kern Regarding Article “Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest: Imaging With CT Angiography”

Jaffe

Shiran

Gaspar

et al. 2009

Circ: Cardiovascular Imaging

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We thank Dr Kern for his thoughtful comments regarding the evaluation and treatment of this patient. We performed primary stenting of a critical narrowing in the midsegment of a left main coronary artery with an anomalous origin from the right coronary sinus and an interarterial course in a patient with cardiac arrest. Follow-up computed tomographic angiography and intravascular ultrasound demonstrated patency of the stent but a slit-like orifice of the artery with a cross-sectional area of 6.3 mm 2 . The patient underwent bypass surgery and has been well for 1 year since then.The decision to refer the patient to surgery was made primarily because of uncertainty regarding possible future mechanical compression of the stented midsegment as it coursed between the aorta and pulmonary artery. We agree that the stenosis of the ostial segment may not have been physiologically significant. However slitlike ostial morphology has been associated with adverse outcome in subjects with this anomaly regardless of the measured crosssectional area. 1 The utility of fractional flow reserve in guiding therapy in this case is unclear because left main lesions were excluded from the FAME study, which is the primary source of outcome data for this technology. 2 We are aware of the risk of graft failure in vessels with non-flow-limiting stenosis; however, our surgical colleagues preferred not to occlude the left main artery at the time of surgery. DisclosuresNone. Ronen

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Anomalous interarterial left coronary artery: An evidence based systematic overview

Cited by 41 publications

References 78 publications

Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest

Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest

Cardiac Arrest and Sudden Cardiac Death in the Pediatric Population

Response to Letter by Kern Regarding Article “Primary Stenting of an Anomalous Left Main Coronary Artery With an Interarterial Course During Cardiac Arrest: Imaging With CT Angiography”

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