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Non‐invasive evaluation of anomalous aortic origin of coronary arteries and surgical management
Author(s) -
Ashwath Ravi,
Prasad Deepa
Publication year - 2016
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.30.1_supplement.230.1
Subject(s) - medicine , coronary arteries , cardiology , aortic sinus , sudden death , sudden cardiac death , right coronary artery , artery , myocardial infarction , left coronary artery , circumflex , coronary sinus , radiology , coronary angiography
Advances in imaging of the coronary arteries allow more detailed and accurate information to be assessed to detect anomalies that might prevent a young athlete dying on the field. Normal coronary anatomy includes origin of left coronary artery from left sinus of Valsava, which then divides into left anterior descending artery and left circumflex coronary artery and origin of right coronary artery from the right sinus. Anomalous aortic origin of coronary arteries (AAOCA) is when the coronary arteries arise from opposite sinus or wrong sinus or as single right or left coronary artery. AAOCA is rare with an incidence of about 0.2%. However, it is the second most common cause of sudden cardiac death in young athletes. Most patients are asymptomatic and sudden death could be the initial presentation, which is provoked by myocardial ischemia leading to myocardial infarction and lethal arrhythmia's. The pathological mechanisms attributed to the coronary compression include, intramural/interarterial course, slit‐like orifice, acute angle take‐off, hypoplastic coronary arteries and coronary artery dominance. Anomalous left coronary artery from right sinus is thought to carry a higher risk of sudden death than anomalous right coronary artery. Echocardiography is a useful tool in the initial evaluation of AAOCA but generally needs to be complemented and confirmed by advanced imaging such as computed tomographic angiography (CTA) or magnetic resonance imaging (MRI). The intramural and interarterial course can be easily determined by CTA and in most cases by MRI. A slit like orifice can be visualized by CTA, however with technological advancements in CT, it is possible to obtain dynamic images of the coronary artery origin, which has enabled us to determine the slit like orifice more accurately. MRI has enabled us to identify myocardial viability by using stress perfusion and late Gadolinium enhancement imaging. Accurate delineation of the coronary anatomy and viability is important in the decision making for management and pre‐operative evaluation. There are various surgical options depending on the type of coronary anomaly and presence of additional risk factors. Support or Funding Information Deepa Prasad M.D. is funded by AAA