Magnetic Resonance Imaging–Based Screening Study in a General Population of Adolescents

Angelini, Paolo; Cheong, Benjamin; Rosen, Veronica V. Lenge De; López, José A.; Uribe, Carlo; Masso, Anthony H.; Ali, Sana; Davis, Barry R.; Muthupillai, Raja; Willerson, James T.

doi:10.1016/j.jacc.2017.11.051

Cited by 35 publications

(30 citation statements)

References 5 publications

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“…Prevalence of AAOCA is still uncertain. 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: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…To this term we add an "L" or "R" prefix to indicate the affected coronary artery (LCA or RCA) and a suffix to indicate the abnormal proximal course: "IM" for intramural, "PP" for prepulmonic, "SP" for subpulmonary, "RA" for retroaortic, "RC" for retrocardiac, or "WA" for wrapping around the apex [4]. L-ACAOS-IM constitutes the most serious group of LCA anomalies [4,5].…”

Section: Introductionmentioning

confidence: 99%

Anatomic spectrum of left coronary artery anomalies and associated mechanisms of coronary insufficiency

Angelini¹,

Uribe²

2018

Cathet Cardio Intervent

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This is a novel re-appraisal of an understudied and misunderstood group of important coronary anomalies. The general name of the group is "anomalous origin of the left coronary artery," but several additional details should be included in this group of anomalies and the explanation of their pathophysiology. The most lethal form in young athletes or military recruits features intramural aortic proximal course. This comprehensive review is based on a large experience at a dedicated center for coronary artery anomalies, using evolving knowledge (over 20 years) while employing prospective and disciplined programs of evaluation and treatment, according to the nature and severity of each anomaly. The most common pathogenic mechanism of coronary dysfunction relates to intramural coronary course, with or without ectopic origin, leading to variable lateral compression and stenosis inside the aortic tunica media; this compression is present at rest and worsens with exertion. We propose that such variable and dynamic stenoses can be best studied by examining their specific anatomy and clinical presentation, stress testing, and, most importantly, in vivo evaluation by intravascular ultrasonography. Such methods should be used to support individual risk evaluation and selection among treatment options.

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“…[34][35][36] CMR has recently been used as a primary screening tool for cardiac anomalies, in particular coronary artery anomalies. 78 Cardiac CT is the imaging modality of choice in the delineation of small anatomical structures such as coronary arteries and collateral arteries and for imaging parenchymal lung pathology.…”

Section: Cross Sectional Imagingmentioning

confidence: 99%

“…| Left-ventricular noncompaction cardiomyopathyLeft-ventricular noncompaction cardiomyopathy (LVNC) in childhood shows an undulating and heterogeneous phenotype of different severity 100. LV hypertrabeculation is not uncommon in the healthy adult athlete,101 and this is similar in the pediatric population,78 however, a definite differentiation between physiological trabeculation and LVNC disease in this age group remains a challenge. Mild hypertrabeculation in the setting of normal function, without CMR features such as wall motion abnormalities or fibrosis, and without evidence of rhythm abnormalities can be regarded as a normal phenomenon, but serial monitoring is advised.…”

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confidence: 99%

The adolescent athlete's heart; A miniature adult or grown‐up child?

Pieles

Stuart

2020

Clinical Cardiology

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The systematic development of early age talent in sports academies has led to the professionalization of pediatric sport and the sports physician need to be aware of pediatric cardiological problems. Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group <12 years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12 years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.

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Magnetic Resonance Imaging–Based Screening Study in a General Population of Adolescents

Cited by 35 publications

References 5 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

Anatomic spectrum of left coronary artery anomalies and associated mechanisms of coronary insufficiency

The adolescent athlete's heart; A miniature adult or grown‐up child?

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