Anomalous origin of coronary arteries from the “wrong” sinus in athletes: Diagnosis and management strategies

Palmieri, Vincenzo; Gervasi, Salvatore Francesco; Bianco, Massimiliano; Cogliani, Roberta; Poscolieri, Barbara; Cuccaro, Francesco; Marano, Riccardo; Mazzari, Mario Attilio; Basso, Cristina; Zeppilli, Paolo

doi:10.1016/j.ijcard.2017.10.117

Cited by 37 publications

(41 citation statements)

References 35 publications

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“…Angelini et al [18] reports a frequency of high risk anomalous coronaries as high as 0.44% in a population of middle and high school healthy volunteers. As described in other studies [1][2][3][4][5][6][18][19][20], we also found that interarterial AORCA was 3 times more frequent than AOLCA.…”

Section: Discussionsupporting

confidence: 90%

“…On the contrary, Maron [21] reported 119 cases among 1866 episodes of SCD related to presence of AAOCA (about 11%). These numbers have been reported among patients practicing high level of physical activity [4][5][6]. Thus, rate of SCD may be expected to be somewhat lower in the general population, which is not necessarily practicing high level sports.…”

Section: Discussionmentioning

confidence: 83%

“…Anomalous aortic coronary origin and course represent a rare congenital heart disease (CHD) whose clinical significance has been only recently better appreciated, due to the technical advancement of imaging and epidemiology. In fact, the Anomalous Aortic Origin of Coronary Artery (AAOCA) from the opposite sinus of Valsalva represents the second leading cause of sudden cardiac death (SCD) in healthy children or young athletes, during or immediately after exercise, often with no prodromes [1][2][3][4][5][6]. Furthermore, an increasing number of children and young adults are being incidentally found to have AAOCA on imaging studies, performed as part of screening campaigns with transthoracic echocardiography (TTE), magnetic resonance imaging (MRI) or for other reasons.…”

Section: Introductionmentioning

confidence: 99%

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Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Padalino

Franchetti

Sarris

et al. 2019

International Journal of Cardiology

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Background: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. Methods: This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Results: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p b 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p b 0.001). Conclusions: Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Padalino

Franchetti

Sarris

et al. 2019

International Journal of Cardiology

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“…It must be noted however that athletes usually have good acoustic windows. When there is suspicion of any coronary anomaly and transthoracic echocardiography images provide insufficient information, an additional CT or MRI-scan should be considered [48]. The coronary artery visibility can be influenced by several factors such as heart rate, body size and the size of the coronary arteries [17,34].…”

Section: Discussionmentioning

confidence: 99%

Coronary anomalies in tetralogy of Fallot – A meta-analysis

Koppel

Jongbloed

Kiès

et al. 2020

International Journal of Cardiology

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Background: An anomalous coronary artery is reported in 2% to 23% of patients with tetralogy of Fallot (TOF). Knowledge of coronary anatomy prior to corrective surgery is vital to avoid damage to vessels crossing the right ventricular outflow tract (RVOT). A meta-analysis on the prevalence of anomalous coronary arteries in TOF is lacking to date. Here, an overview of coronary anomalies in TOF is provided and implications for patient management are discussed. Methods: PubMed, Embase and Web of Science were searched. Analysis was done using Revman 5.3 (Cochrane Community, London). The primary analysis focused on the origin and proximal course of the right and left coronary arteries. In addition, the prevalence of large conus arteries and coronary arteriovenous fistulas (CAVF) was calculated. Results: Twenty-eight studies, encompassing 6956 patients, were included; 6% of TOF patients have an anomalous coronary artery. Hereof, 72% cross the RVOT; the majority of the remaining 28% courses behind the aorta. Six percent of patients have a large conus artery and 4% a CAVF. Other coronary anomalies include a left or right coronary artery from the pulmonary trunk or left or right pulmonary artery, coronary tree hypoplasia and anastomoses between coronary and bronchial arteries. Conclusions: The prevalence of coronary anomalies in TOF is 4-6%. In patients with an anomalous coronary artery, 72% cross the RVOT. The combined risk of encountering an anomalous coronary artery or a large conus artery crossing the RVOT is 10.3%. Coronary anatomy should be defined before surgery and the surgical approach adapted accordingly.

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“…The anomalous origin of the coronary artery (AAOCA) is a common congenital coronary artery anomaly [1]. Although some children are born with AAOCA, the condition may not be diagnosed during coronary angiography until the individual grows to an adolescence or adulthood [2][3][4]. There are four main types of AAOCA: (a) absence of left main artery; (b) abnormal origin of the coronary artery from the improper sinus; (c) anomalous coronary ostium outside of Valsalva's sinus; (d) a single coronary artery [1].…”

Section: Introductionmentioning

confidence: 99%

Influence of malformation of right coronary artery originating from the left sinus in hemodynamic environment

Cong

Qiu

et al. 2020

BioMed Eng OnLine

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Background: The anomalous origin of the right coronary artery (RCA) from the left coronary artery sinus (AORL) is one of the abnormal origins of the coronary arteries. Most of these issues rarely have any effects on human health, but some individuals may exhibit symptoms, such as myocardial ischemia or even sudden death. Recently, researchers have investigated the AORL through clinical cases, but studies based on computational fluid dynamics (CFD) have rarely been reported. In this study, the hemodynamic changes between the normal origin of the RCA and the AORL are compared based on numerical simulation results. Methods: Realistic three-dimensional (3D) models of the 16 normal right coronary arteries and 26 abnormal origins of the RCAs were constructed, respectively. The blood flow was numerically simulated using the ANSYS software. This study used a one-way fluid-solid coupling finite element model, wherein the blood is assumed to be an incompressible Newtonian fluid, and the vessel is assumed to be made of an isotropic linear elastic material. Results: The cross-sectional area differences between the inlet of the normal group and that of the abnormal group were significant (P < 0.0001). Moreover, there were significant differences in the volumetric flow (P = 0.0001) and pressure (P = 0.0002). Positive correlation exists for the ratio of the cross-sectional area of the RCA to the inlet area of the ascending aorta (AAO), and the ratio of the inlet volumetric flow of the RCA to the volumetric flow of the AAO, in the normal (P = 0.0001, r = 0.8178) and abnormal (P = 0.0033, r = 0.6107) groups. Conclusion: This study demonstrates that the cross-sectional area of the AORL inlet may cause ischemia symptoms. The results obtained by this study may contribute to the further understanding of the clinical symptoms of the AORL based on the hemodynamics.

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Anomalous origin of coronary arteries from the “wrong” sinus in athletes: Diagnosis and management strategies

Cited by 37 publications

References 35 publications

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Coronary anomalies in tetralogy of Fallot – A meta-analysis

Influence of malformation of right coronary artery originating from the left sinus in hemodynamic environment

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