Beta-Blockade in Intraseptal Anomalous Coronary Artery With Reversible Myocardial Ischemia

Doan, Tam; Qureshi, Athar M.; Sachdeva, Shagun; Noel, Cory V.; Reaves-O’Neal, Dana; Molossi, Silvana

doi:10.1177/2150135120954818

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…One patient with exertional chest pain and inducible ischemia was started on beta-blockade and had resolution of chest pain, no perfusion abnormality on DSCMR, and normalized fractional flow reserve/instantaneous wave-free ratio at follow-up. 22 Another patient was prescribed beta-blockade therapy, has remained asymptomatic and has not returned for repeat testing. Two patients have been monitored with no intervention.…”

Section: Resultsmentioning

confidence: 99%

“…Although this specific type of AAOLCA was previously considered a benign entity requiring no intervention or exercise restrictions, our data depicted a subset of patients at risk of myocardial ischemia who presented with recurrent exertional syncope/chest pain and prior myocardial infarction. 18,22,27 Surgical intervention has been reported in case series with improved symptoms and resolved evidence of ischemia in most cases. [18][19][20][21]27 Given the extent of intervention, the lack of long-term results, and the less malignant nature of this type, we remain cautious and would offer surgery to the symptomatic patient with evident inducible ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21]27 Given the extent of intervention, the lack of long-term results, and the less malignant nature of this type, we remain cautious and would offer surgery to the symptomatic patient with evident inducible ischemia. 18,21 In addition, we are cautiously optimistic about the use of beta blocker in patients whom surgery was not pursued, 22 although the mechanism of action is yet to be unraveled. There remains much for us to learn about this group of patients and careful assessment of each individual patient is helpful, particularly in centers with expertise to perform noninvasive and invasive provocative testing.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course

Doan

Wilkes

Reaves-O’Neal

et al. 2023

Circ: Cardiovascular Interventions

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Background: Anomalous aortic origin of the left coronary artery (AAOLCA) confers a rare, but significant, risk of sudden cardiac death in children. Surgery is recommended for interarterial AAOLCA, and other subtypes considered benign. We aimed to determine the clinical characteristics and outcomes of 3 AAOLCA subtypes. Methods: All patients with AAOLCA <21 years old were prospectively enrolled (December 2012–November 2020), including group 1: AAOLCA from the right aortic sinus with interarterial course, group 2: AAOLCA from the right aortic sinus with intraseptal course, and group 3: AAOLCA with a juxtacommissural origin between the left and noncoronary aortic sinus. Anatomic details were assessed using computed tomography angiography. Provocative stress testing (exercise stress testing and stress perfusion imaging) was performed in patients >8 years old or younger if concerning symptoms. Surgery was recommended for group 1 and in select cases in group 2 and group 3. Results: We enrolled 56 patients (64% males) with AAOLCA (group 1, 27; group 2, 20; group 3, 9) at median age of 12 years (interquartile range, 6–15). Intramural course was common in group 1 (93%) compared with group 3 (56%) and group 2 (10%). Seven (13%) presented with aborted sudden cardiac death (group 1, 6/27; group 3, 1/9); 1 (group 3) with cardiogenic shock. Fourteen/42 (33%) had inducible ischemia on provocative testing (group 1, 32%; group 2, 38%; group 3, 29%). Surgery was recommended in 31/56 (56%) patients (group 1, 93%; group 2, 10%; and group 3, 44%). Surgery was performed in 25 patients at a median age 12 (interquartile range, 7–15) years; all have been asymptomatic and free from exercise restrictions at median follow-up of 4 (interquartile range, 1.4–6.3) years. Conclusions: Inducible ischemia was noted in all 3 AAOLCA subtypes while most aborted sudden cardiac deaths occurred in interarterial AAOLCA (group 1). Aborted sudden cardiac death and cardiogenic shock may occur in AAOLCA with left/nonjuxtacommissural origin and intramural course, thus also deemed high-risk. A systematic approach is essential to adequately risk stratify this population.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course

Doan

Wilkes

Reaves-O’Neal

et al. 2023

Circ: Cardiovascular Interventions

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“…Surgery or medical intervention would be considered based on individual patient discussion and recommended for patients with a positive DSCMR. If a patient is undergoing surgical repair of AAOCA, a similar approach would be used routinely at 3 months after surgery and help inform return to activities [15][16][17][18][19].…”

Section: Utility Of Dscmr Resultsmentioning

confidence: 99%

Dobutamine stress cardiac MRI is safe and feasible in pediatric patients with anomalous aortic origin of a coronary artery (AAOCA)

Doan

Molossi

Sachdeva

et al. 2021

International Journal of Cardiology

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Background: Risk strati cation in anomalous aortic origin of a coronary artery (AAOCA) is challenged by the lack of a reliable method to detect myocardial ischemia. We prospectively studied the safety and feasibility of Dobutamine stress-cardiac magnetic resonance (DSCMR), a test with excellent performance in adults, in pediatric patients with AAOCA. Methods: Consecutive DSCMR from 06/2014-12/2019 in patients 20 years old with AAOCA were included. Hemodynamic response and major/minor events were recorded. Image quality and spatial/temporal resolution were evaluated. Rest and stress rst-pass perfusion and wall motion abnormalities (WMA) were assessed. Inter-observer agreement was assessed using kappa coe cient.Results: A total of 224 DSCMR were performed in 182 patients with AAOCA at a median age of 14 years (IQR 12,16) and median weight of 58.0 kg (IQR 43.3, 73.0). Examinations were completed in 221/224 (98.9%), all studies were diagnostic. Heart rate and blood pressure increased signi cantly from baseline (p<0.001). No patient had major events and 28 (12.5%) had minor events. Inducible hypoperfusion was noted in 31/221 (14%), associated with WMA in 13/31 (42%). Inter-observer agreement for inducible hypoperfusion was very good (K= 0.87). Asymptomatic patients with inducible hypoperfusion are considered high-risk and those with a negative test are of standard risk.Conclusions: DSCMR is feasible in pediatric patients with AAOCA to assess for inducible hypoperfusion and WMA. It can be performed safely with low incidence of major/minor events. Thus, DSCMR is potentially a valuable test for detection of myocardial ischemia and helpful in the management of this patient population.

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Pediatric Patients: Role of Invasive and Provocative Tests

Molossi,

Doan

2023

Congenital Anomalies of Coronary Arteries

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Beta-Blockade in Intraseptal Anomalous Coronary Artery With Reversible Myocardial Ischemia

Cited by 8 publications

References 5 publications

Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course

Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course

Dobutamine stress cardiac MRI is safe and feasible in pediatric patients with anomalous aortic origin of a coronary artery (AAOCA)

Pediatric Patients: Role of Invasive and Provocative Tests

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