Evaluation of Myocardial Ischemia After Surgical Repair of Anomalous Aortic Origin of a Coronary Artery in a Series of Pediatric Patients

Abstract

Subclinical changes suggestive of ischemia might occur despite patent neo-coronary ostia, notably after ARCA repair. The implication of these results on indication for surgery and subsequent sudden death risk is unknown. Serial EST, SE, and MPS are essential in evaluating ongoing ischemia risk after AAOCA repair.

Long-Term Outcome and Impact of Surgery on Adults With Coronary Arteries Originating From the Opposite Coronary Cusp

“…38 -41 Unfortunately, aortic insufficiency can result, even late after surgery, 41 and myocardial ischemia may persist in this population, particularly in patients with repaired ARCA with IAC. 42 The third major surgical option is reimplantation of the coronary artery into the proper sinus. It is a technically demanding procedure that requires extensive dissection and mobilization and can only be performed in patients with very specific coronary anatomy (no slit-like orifice, intramural segment, or common ostium with the other coronary artery).…”

Proximal Anomalous Connections of Coronary Arteries in Adults

“…Functional results of modern surgical methods are recognized as good in young people with most of patients free of symptoms at a mediumterm follow-up (Erez et al, 2006, Karl, et al 2010). However, Brothers et al reported that subclinical ischemia may occur after surgical repair of anomalous aortic origin of a coronary artery (Brothers et al, 2007). In this study, 9 asymptomatic children or adolescents (5 to 18 years) had post operative evaluations (range 2 to 48 months) suggestive of silent ischemia.…”

“…Medical treatment with essentially beta-blockers is sometimes associated. Due to possible but rare late deaths or subclinical myocardial ischemia after surgical repair of ANOCOR, long-term follow-up with regular cardiovascular evaluation is needed (Brothers et al, 2007, Brothers et al, 2009. Presence of significant atherosclerotic coronary disease or valvular disease requiring cardiac surgery permits sometimes a concomitant treatment of a high-risk ANOCOR.…”

“…The low incidence of ANOCOR requiring a percutaneous or a surgical repair would justify that these congenital abnormalities being taken care off in a center specialized in the management of ANOCOR. Several attempts have been made to set up observational registries to determine the outcome of different strategies in the field of ANOCOR (Angelini 2007, Aubry et al, 2008, Brothers et al, 2007, Pelliccia, 2001. To date, two registries are ongoing, one in North and South America, and one in France.…”

The Management of Athletes with Congenital Heart Disease

“…However, the stress test has limitations given that in published series it rarely is positive for ischemia, even in those who suffered sudden death. 39,47 Similarly, stress nuclear myocardial perfusion carries the same burden of false positive and false negative results. Imaging is crucial in determining details of ostial anatomy and course of the anomalous vessel.…”