Noninvasive Multimodality Imaging for the Assessment of Anomalous Coronary Artery

• Published in: Current cardiology reports Vol. 25; no. 10; pp. 1233 - 1246
• Main Authors: Gräni, Christoph, Bigler, Marius R., Kwong, Raymond Y.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2023
• Subjects: Aorta; Cardiology; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessels - diagnostic imaging; Humans; Medicine; Medicine & Public Health; Myocardial Ischemia - complications; Section Editor; Structural Heart Disease (S Vakamudi; Tomography, X-Ray Computed; Topical Collection on Structural Heart Disease; Dynamic stenosis; Fixed stenosis; Assessment of hemodynamic relevance; Multimodality imaging; Anomalous aortic origin of a coronary artery; AAOCA
• ISSN: 1523-3782; 1534-3170
• DOI: 10.1007/s11886-023-01948-w

Purpose of Review Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary anomaly with the potential to cause myocardial ischemia and adverse cardiac events. The presence of AAOCA anatomy itself does not necessarily implicate a need for revascularization. Therefore, the purpose of this review is to assess how noninvasive comprehensive anatomic- and physiologic evaluation may guide patient management. Recent Findings The assessment of AAOCA includes an accurate description of the anomalous origin/vessel course including anatomical high-risk features such as a slit-like ostium, proximal narrowing, elliptic vessel shape, acute take-off angle, intramural course, and possible concomitant coronary atherosclerosis and hemodynamics. Various cardiac imaging modalities offer unique advantages and capabilities in visualizing these anatomical and functional aspects of AAOCA. Summary This review explored the role of noninvasive multimodality imaging in the characterization of AAOCA by highlighting the strengths, limitations, and potential applications of the current different cardiac imaging methods, with a focus on the pathophysiology of myocardial ischemia and stress testing protocols.