Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach

Abstract

Background: Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm. Methods: Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy—anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium—and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk. Results: Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7–2.8) years. Conclusions: In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.

Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study

“…Competitive athletes at the middle school (ages 11-13), high school including premiere/select level (ages 14-18), college (ages 19-23), semiprofessional and professional levels (ages [24][25][26][27][28][29] who experienced SCA/D were included. A competitive athlete was defined as an individual at least 11 years of age involved in regular training in an organised individual or team sport with an emphasis on competition and performance.…”

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

“…5 It has been adopted in children with coronary artery anomaly and ischemia, in whom the risk of surgical intervention outweighs the Submitted April 21, 2020; Accepted August 07, 2020. benefit, such as in this case. 6 Although withholding the b-blocker for 24 hours might not have allowed for a complete assessment of the treatment efficacy, it may not have eliminated the many immediate and long-term potential benefits that b-blockade has on the affected myocardium. Further follow-up is necessary to understand the natural history of this rare anomaly, the potential effects of b-blockade, and which patients would benefit from surgery versus b-blockade.…”

An Extremely Rare Case of Anomalous Left Main Coronary Artery Originating From Single Right Coronary Ostium Managed Using Heart Team Approach

“…Recently, Farooqi et al reported recommendations for CT imaging and a 3D digital model for evaluation of such anomalies [8]. Similarly, other investigators have advocated for a multispecialty discussion as Heart Team approach between interventional cardiologist and cardiothoracic surgeons [9].…”