Symptomatic Coronary Anomalies and Ischemia in Teenagers – Rare but Real

Borns, Julia; Gräni, Christoph; Kadner, Alexander; Gloeckler, Martin; Pfammatter, Jean‐Pierre

doi:10.3389/fcvm.2020.559794

Cited by 5 publications

(6 citation statements)

References 8 publications

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“…All patients required an operation for revascularization and one of them remained symptomatic and was a candidate for heart transplantation. 7 …”

Section: Discussionmentioning

confidence: 99%

“…All patients required an operation for revascularization and one of them remained symptomatic and was a candidate for heart transplantation. 7 Brothers et al suggested that the anomalous arterial anatomy is more prone to dynamic compression and may put the heart at risk of myocardial infarction. 8 On the other hand, Woudstra et al indicated that infectious myocarditis causes injury to the cardiac vasculature and subsequent dysregulation of vascular tone including coronary vasospasm.…”

Section: Discussionmentioning

confidence: 99%

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COVID-19-induced myocarditis in patient with anomalous origin of the left circumflex artery from the right coronary artery: a case report

et al. 2022

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The prevalence of coronary artery anomalies has been increasing due to the increasing usage of coronary angiography. There is a paucity of literature concerning management of viral-induced myocarditis in patients with anomalous coronary artery. We present a very unusual case of a 44-year-old man with anomalous origin of the left circumflex artery from the proximal ostium of the right coronary artery who was admitted for COVID-19-induced myocarditis. He presented with signs of heart failure and coronary angiography revealed the left circumflex artery with a separate ostium originating from the proximal right coronary artery. He was treated medically with Bisoprolol, Perindopril Arginine, Rivaroxaban, and Furosemide. His condition improved rapidly and he resumed regular life within 1 month. Coexistence of cardiac disease such as viral-induced myocarditis with an underlying anomalous origin of the coronary artery is challenging to spot and can lead to worse outcomes in case of misdiagnosis and inaccurate management.

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“…All patients required an operation for revascularization and one of them remained symptomatic and was a candidate for heart transplantation. 7 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

COVID-19-induced myocarditis in patient with anomalous origin of the left circumflex artery from the right coronary artery: a case report

et al. 2022

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“… 6 , 11 , 28 , 37 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 Besides acute ischemia–induced arrhythmias, repetitive minor ischemic events with consecutive myocardial fibrosis may serve as a substrate for ventricular tachyarrhythmias and SCD. 6 , 65 Consequently, multimodality diagnostic management of patients with ACAOS should not only imply the detection of anatomic high‐risk features and myocardial ischemia of ACAOS but also provide information for possible myocardial fibrosis/scar in suspected cases (Figure 2 ). 14 , 15 , 30 …”

Section: Diagnostic Management Of Acaosmentioning

confidence: 99%

“… 22 Of note, in patients with ACAOS presenting in an acute setting (ie, myocardial infarction, troponin leakage) direct revascularization should be aimed. 65 Based on previous studies showing a reduced risk for potentially serious adverse events with increasing age, 13 , 33 , 35 , 66 the diagnostic downstream testing recommendations have been adapted to age (below and above 30 years old). One has to be aware that dichotomization of the age 30 years is arbitrary and should not be seen as a stringent recommendation but should rather be seen as a guidance.…”

Section: Diagnostic Management Of Acaosmentioning

confidence: 99%

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Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing

Bigler

Kadner

Räber

et al. 2022

JAHA

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Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are a challenge because of their various anatomic and clinical presentation. Although the prevalence is low, the absolute numbers of detected ACAOS are increasing because of the growing use of noninvasive anatomical imaging for ruling out coronary artery disease. As evidence‐based guidelines are lacking, treating physicians are left in uncertainty for the optimal management of such patients. The sole presence of ACAOS does not justify surgical correction, and therefore a thorough anatomic and hemodynamic assessment is warranted. Invasive and noninvasive multimodality imaging provides information to the clinical question whether the presence of ACAOS is an innocent coincidental finding, is responsible for the patient’s symptoms, or even might be a risk for sudden cardiac death. Based on recent clinical data, focusing on the pathophysiology of patients with ACAOS, myocardial ischemia is dependent on both the extent of fixed and dynamic components, represented by anatomic high‐risk features. These varying combinations should be considered individually in the decision making for the different therapeutic options. This state‐of‐the‐art review focuses on the advantages and limitations of the common contemporary surgical, interventional, and medical therapy with regard to the anatomy and pathophysiology of ACAOS. Further, we propose a therapeutic management algorithm based on current evidence on multimodality invasive and noninvasive imaging findings and highlight remaining gaps of knowledge.

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Safety and efficacy of surgical correction of anomalous aortic origin of coronary arteries: experiences from 2 tertiary cardiac centres

Pregaldini

Widenka

Barghout

et al. 2023

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES This study aims to describe the outcomes of surgical correction for anomalous aortic origin of coronary artery (AAOCA) with regard to symptom relief. METHODS We performed a retrospective multicentre study including surgical patients who underwent correction for AAOCA between 2009 and 2022. Patients who underwent concomitant cardiac procedures were also included. However, to analyze symptom relief we only assessed the subgroup of symptomatic patients who underwent isolated correction for AAOCA. RESULTS A total of 71 consecutive patients (median age 55, range 12–83) who underwent surgical correction for AAOCA were included in the study. Right-AAOCA was present in 56 patients (79%), left-AAOCA in 11 patients (15%), single coronary ostium AAOCA in 4 patients (6%). Coronary unroofing was performed in 72% of the patients, coronary reimplantation in 28% and an additional neo-ostium patchplasty in 13% of the patients. In 39% of the patients a concomitant cardiac procedure was performed. During follow-up, no cardiovascular-related death was observed. Three patients (4.2%) had a myocardial infarction and underwent postoperative coronary artery bypass grafting. Six patients (8.5%) needed postoperative temporary mechanical circulatory support. Among the 34 symptomatic patients who underwent isolated AAOCA correction, 70% were completely asymptomatic after surgery, 12% showed symptom improvement and no symptom improvement was observed in 18% of the patients (median follow-up 3.5 years, range 0.3–11.1). CONCLUSIONS Correction for AAOCA can be safely performed with or without concomitant cardiac procedures. Performing AAOCA correction leads to a significant improvement in symptoms for most patients.

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Symptomatic Coronary Anomalies and Ischemia in Teenagers – Rare but Real

Cited by 5 publications

References 8 publications

COVID-19-induced myocarditis in patient with anomalous origin of the left circumflex artery from the right coronary artery: a case report

COVID-19-induced myocarditis in patient with anomalous origin of the left circumflex artery from the right coronary artery: a case report

Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing

Safety and efficacy of surgical correction of anomalous aortic origin of coronary arteries: experiences from 2 tertiary cardiac centres

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