Current Management of Anomalous Aortic Origin of a Coronary Artery: A Pan-Canadian Survey

Rahmouni, Kenza; Bernier, Paule

doi:10.1177/2150135121999030

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…Surgery is recommended for all patients with AAOLCA in that guidance, leaving little need for risk strati cation. However, as was seen in the Canadian survey (24), an important minority of our respondents did not advocate surgical repair of AAOLCA in the absence of ischemia on stress imaging and the frequent recommendation for stress testing in AAOLCA may suggest that some cardiologists do see a role for risk strati cation in AAOLCA.…”

Section: Discussionmentioning

confidence: 65%

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A Survey on the Management of Anomalous Aortic Origins of the Coronary Arteries

2023

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Background: The management of patients with an anomalous aortic origin of a coronary artery (AAOCA) remains controversial despite the publication of the 2017 American Association for Thoracic Surgery (AATS) expert guidelines.Methods: We surveyed the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and the Pediheart.net online community regarding their care of patients with anomalous origins of the right or left coronary from the opposite cusp with inter-arterial courses and compared them to the AATS guidelines Results: We received 111 complete responses. Four notable variations from the AATS recommendations were identi ed. Respondents were more likely to use ECG exercise testing than the stress imaging recommended in the AATS guidelines.For a 16-year-old with AAOCA, recommendations for surgery generally followed the AATS guidelines.However, for asymptomatic left AAOCA without signs of ischemia on stress imaging, only 69.4% felt surgery was appropriate or somewhat appropriate.In the setting of a 16-year-old with right AAOCA free from signs or symptoms of ischemia, respondents were more likely to recommend surgery if the patient was a competitive athlete, a topic not directly addressed in the AATS guidelines.After surgical treatment of AAOCA, only 24% of respondents recommended lifelong antiplatelet therapy despite recommendations for this in the AATS guidelines.Conclusion: Respondents recommendations were generally consistent with the 2017 AATS guidelines but with important variations in the use of stress imaging, indications for surgery in asymptomatic left AAOCA, the impact of identi cation as a competitive athlete and duration of postoperative antiplatelet therapy.

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Section: Discussionmentioning

confidence: 65%

“…(23) Respondents to a survey of Canadian pediatric cardiologists and congenital heart surgeons published in 2021 were much less likely to recommend surgery for asymptomatic patients with AAOLCA and symptomatic patients with AAORCA than would be recommended in the 2017 AATS guidelines. (24)…”

Section: Introductionmentioning

confidence: 99%

A Survey on the Management of Anomalous Aortic Origins of the Coronary Arteries

2023

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“…[ 70 ] AAOCA is the second most common cause of SCD in children and adolescents, after hypertrophic cardiomyopathy (HCM). [ 71 ] High-risk features include intramural course, interarterial course, slit-like ostium, or acute angulation. [ 71 ].…”

Section: Congenital Anomaly Of the Coronary Arterymentioning

confidence: 99%

“…[ 71 ] High-risk features include intramural course, interarterial course, slit-like ostium, or acute angulation. [ 71 ]. A ‘scissor-like’ physiologic effect has been proposed in case of an interarterial AAOCA course, in which coronary artery compression between the great vessels occurs during times of high cardiac output, like exercise, leading to myocardial ischemia,[ 72 ] lethal ventricular arrhythmia or SCD.…”

Section: Congenital Anomaly Of the Coronary Arterymentioning

confidence: 99%

Guidelines for physical activity in children with heart disease

Shah¹,

Mohanty²,

Karande³

et al. 2022

Annals of Pediatric Cardiology

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Justification: In recent years, there has been increasing recognition of children with heart disease in our country. These children belong to different age groups and have untreated, partially treated, or completely treated heart disease. The role of physical activity for optimal physical, emotional, and psychosocial well-being for children is well understood. There is a challenge for the parents and the medical professionals to take a decision regarding the type of physical activity safe for the child as heart disease may affect the hemodynamic demands. Most of the existing international guidelines focus on competitive sports in operated heart disease children. This may be of limited use when we have a mixed population of children with heart disease, different types of sports in our country and where a larger subset is looking for recommendations to leisure time activities. Process: The Pediatric Cardiac Society of India decided to formulate recommendations for physical activity in children with heart diseases. A committee of experts, who were well-versed with the subject of physical activity in children with heart disease, volunteered to take up the task of writing the guidelines. The recommendations emerged following deliberations of the committee members, on the virtual platform as well as mails. The final version of manuscript was approved by all committee members and all members are co-authors of this manuscript. The different types of physical activities were defined including leisure sports and competitive sports. The exercise was classified based on the mechanical action of muscles involved into dynamic and static components. Each type of exercise was then classified based on the intensity into low, medium, and high. Recommendations for the type of physical activity for individual heart lesions were decided based on the rationale available. Objectives: The recommendations here are made with an intention to provide general guidelines for physical activity in children with operated and unoperated heart diseases, not excluding a need for individualizing a plan, serial assessment, and comprehensive checkup in special situations. Recommendations: We hope the recommendations mentioned below would provide basic clarity in planning physical activity in children with heart disease. This is with the hope to encourage physically active life, at the same time ensuring a safety net.

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“…Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital cardiac abnormality that typically involves the left main coronary artery arising from the right sinus of Valsalva or the right coronary artery (RCA) arising from the left sinus [ 1 , 2 ]. In our case, coronary computed tomography (CT) showed that the RCA originated from the left sinus of Valsalva, indicating AAORCA.…”

Section: Introductionmentioning

confidence: 99%

Direct Coronary Artery Reimplantation of Anomalous Aortic Origin of the Right Coronary Artery: A Case Report

Katoh,

Ohki,

Yamaguchi

et al. 2023

Cureus

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Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital cardiac abnormality. Although AAOCA can cause angina, syncope, palpitations, and sudden cardiac death, most patients remain asymptomatic. A 60-year-old woman experienced occasional chest discomfort. A coronary computed tomography (CT) showed that the right coronary artery (RCA) originated from the left sinus of Valsalva, indicating AAORCA. Exercise myocardial scintigraphy revealed ischemia in the inferior wall. Cardiac catheterization showed stenosis in the ostium of the RCA. Therefore, direct reimplantation of the RCA into the right sinus was performed under cardiopulmonary bypass. The patient recovered uneventfully, postoperatively. Postoperative coronary CT showed no evidence of bending or stenosis in the RCA. Moreover, exercise scintigraphy showed no ischemic changes. The patient was discharged on postoperative day 18 after the resolution of chest discomfort and remained healthy for the following one year. AAORCA is a rare congenital abnormality that could lead to sudden cardiac death. Appropriate imaging studies and surgery should be performed in symptomatic patients with AAORCA who have inter-arterial paths between the ascending aorta and pulmonary artery with right coronary ostial stenosis. Reimplantation of the RCA directly into the right coronary sinus with adequate mobilization of the RCA is a simple procedure that can return the anatomic and biophysiologic status of AAORCA patients to normal and resolve most morphologic abnormalities.

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Current Management of Anomalous Aortic Origin of a Coronary Artery: A Pan-Canadian Survey

Cited by 12 publications

References 25 publications

A Survey on the Management of Anomalous Aortic Origins of the Coronary Arteries

A Survey on the Management of Anomalous Aortic Origins of the Coronary Arteries

Guidelines for physical activity in children with heart disease

Direct Coronary Artery Reimplantation of Anomalous Aortic Origin of the Right Coronary Artery: A Case Report

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