Echocardiographic screening for the anomalous aortic origin of coronary arteries

Abstract

AimsWe sought to determine the diagnostic performance, clinical profiles and outcomes of anomalous aortic origin of coronary arteries (AAOCA) using a standardised echocardiographic approach in young adults and athletes.MethodsIn 2015–2019, we screened 5998 outpatients (age 16 years (Q1–Q3: 11, 36)), referred for routine echocardiography, using four specific echocardiographic windows: parasternal short/long axis and apical 4/5-chambers view. Coronary CT confirmed AAOCA. For the performance analysis, 300 coronary-CT scans were available; two independent and double-blinded physicians retrospectively reviewed echocardiographic images.ResultsA total of 47 AAOCA was diagnosed; the overall prevalence was 0.0078%. Over 5 years, we found a significant increment of AAOCA diagnostic rate (P for trend=0.002). Syncope (n=17/47) and palpitations (n=6/47) were prevalent symptoms. All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgery, while 20 underwent a conservative medical treatment. All patients are alive at a median follow-up of 3±1.6 years; only surgical repairs restarted their activity. Our method showed better sensitivity than traditional short-axis evaluation: 93% vs 83%, p=0.0030 (AUC 0.96 (95% CI 0.92, 0.99) and AUC 0.89 (95% CI 0.83, 0.95), respectively), with a good interobserver agreement (95%, k=0.83, p<0.001).ConclusionsThe application of a standardised echocardiographic approach for AAOCA detection led to a significantly increased rate of identified anomalies. This approach demonstrated higher sensitivity than the traditional echocardiographic assessment. Implementing this protocol in clinical practice may help improve the AAOCA diagnosis in young adults and athletes.Trial registration numberNCT04224090.

Coronary unroofing does not fits all anomalous aortic origin of coronary arteries

“…5 Many groups, including ours, have developed specific programs for the screening and management of AAOCA. 11,16 Risk stratification and indication to surgery, besides the anatomic evaluation, have encompassed different functional studies aiming to asses cardiac perfusion. Molossi and coll.…”

“…A standardized echocardiographic protocol has been developed in these years in our institution for the diagnosis of AAOCA. 16 Transthoracic echocardiography (TTE) and computed tomography scan were performed in all patients. Echocardiographic studies were performed using commercially available Philips iE33 ultrasound systems (Philips Medical Systems), using a 2.…”

Diagnostic Yield of Non-Invasive Testing in Patients with Anomalous Aortic Origin of Coronary Arteries: A Multicentric Experience

“…Previous studies have highlighted how echocardiographic examination of coronary artery ostia can be feasible and reliable in high percentages of young athletes, in which the quality of acoustic windows is generally optimal [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. High expertise, broader experience, and dedicated or standardized protocols are therefore required in the evaluation of coronary arteries in echocardiography in order to increase further the diagnostic accuracy for AAOCA [24,25].…”

Tetralogy of fallot in addition to anomalous aortic origin of a coronary artery in a 1-year-old boy: a case report

“…Selective coronary angiography was considered as a “golden standard” method to diagnose AAOCA, nevertheless, it is not a suitable method for screening. As a noninvasive method, echocardiographic screening was recommended to recognize AAOCA in TOF patients recently study [ 16 ].…”