Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach
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 st...
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Published in | Circulation. Cardiovascular interventions Vol. 13; no. 2; p. e008445 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
American Heart Association, Inc
01.02.2020
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Abstract | 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.
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.
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.
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. |
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AbstractList | 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.
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.
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.
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. BACKGROUNDAnomalous 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. METHODSPatients 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. RESULTSOf 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. CONCLUSIONSIn 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. |
Author | Fraser, Charles D. Noel, Cory V. Krishnamurthy, Rajesh Sexson Tejtel, S. Kristen McKenzie, E. Dean Mery, Carlos M. Agrawal, Hitesh Masand, Prakash Jadhav, Siddharth P. Molossi, Silvana Qureshi, Athar M. |
AuthorAffiliation | Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Section of Pediatric Radiology (P.M., S.P.J.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery (E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Invasive Cardiac Imaging and Interventional Catheterization Laboratory, Le Bonheur Children’s Hospital, The University of Tennessee Health Sciences Center, Memphis (H.A.). Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children’s Medical Center, Austin (C.M.M., C.D.F.). Division of Pediatric Radiology, Nationwide Children’s Hospital, Columbus, OH (R.K.). Seattle Children’s Pediatric Cardiology of Alaska, Seattle Children’s Hospital, Anchorage (C.V.N.) |
AuthorAffiliation_xml | – name: Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Section of Pediatric Radiology (P.M., S.P.J.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery (E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Invasive Cardiac Imaging and Interventional Catheterization Laboratory, Le Bonheur Children’s Hospital, The University of Tennessee Health Sciences Center, Memphis (H.A.). Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children’s Medical Center, Austin (C.M.M., C.D.F.). Division of Pediatric Radiology, Nationwide Children’s Hospital, Columbus, OH (R.K.). Seattle Children’s Pediatric Cardiology of Alaska, Seattle Children’s Hospital, Anchorage (C.V.N.) |
Author_xml | – sequence: 1 givenname: Silvana surname: Molossi fullname: Molossi, Silvana organization: Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Section of Pediatric Radiology (P.M., S.P.J.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery (E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston. Invasive Cardiac Imaging and Interventional Catheterization Laboratory, Le Bonheur Children’s Hospital, The University of Tennessee Health Sciences Center, Memphis (H.A.). Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children’s Medical Center, Austin (C.M.M., C.D.F.). Division of Pediatric Radiology, Nationwide Children’s Hospital, Columbus, OH (R.K.). Seattle Children’s Pediatric Cardiology of Alaska, Seattle Children’s Hospital, Anchorage (C.V.N.) – sequence: 2 givenname: Hitesh surname: Agrawal fullname: Agrawal, Hitesh – sequence: 3 givenname: Carlos surname: Mery middlename: M. fullname: Mery, Carlos M. – sequence: 4 givenname: Rajesh surname: Krishnamurthy fullname: Krishnamurthy, Rajesh – sequence: 5 givenname: Prakash surname: Masand fullname: Masand, Prakash – sequence: 6 givenname: S. surname: Sexson Tejtel middlename: Kristen fullname: Sexson Tejtel, S. Kristen – sequence: 7 givenname: Cory surname: Noel middlename: V. fullname: Noel, Cory V. – sequence: 8 givenname: Athar surname: Qureshi middlename: M. fullname: Qureshi, Athar M. – sequence: 9 givenname: Siddharth surname: Jadhav middlename: P. fullname: Jadhav, Siddharth P. – sequence: 10 givenname: E. surname: McKenzie middlename: Dean fullname: McKenzie, E. Dean – sequence: 11 givenname: Charles surname: Fraser middlename: D. fullname: Fraser, Charles D. |
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Snippet | Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and... BACKGROUNDAnomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial... |
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