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Newer Concepts in Coronary Artery Anomalies, Based on Accurate In‐vivo Imaging (IVUS)
Author(s) -
Angelini Paolo Enzo,
Uribe Carlo e
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.230.2
Subject(s) - medicine , sudden cardiac death , cardiology , culprit , population , intravascular ultrasound , sudden death , stenosis , athletes , coronary artery disease , radiology , physical therapy , myocardial infarction , environmental health
Objectives An update on novel concepts in the understanding of coronary anomalies anatomy and their pathophysiology. Methods A review of our Center's multiple investigations in these fields (80 publications in 26 years). Results Anatomic rare variants are frequent (up to 5.6% of a general population), and need to be properly recognized. At the end, Anomalous Coronary Artery Origin off an improper sinus of Valsalva (ACAOS) results to be the main culprit of sudden cardiac death in the young athletes and/or, in a few carriers, cause of important symptoms at any age. These anomalies were observed in a recent study of ours, based on an MRI prospective study, in 1.1% of a general schoolchildren population (that translates in about 2 million people in the US). This finding calls for the need to identify any predictive markers of the risk of sudden cardiac death (SCD). Stenosis of a coronary artery is the only known means of its dysfunction. Symptoms, participation in strenuous exercises, stress testing and intravascular ultrasounds imaging (when indicated to clarify its severity and to guide indications for interventions) seem to be the main indicators of risk. Still, SCD may be the most frequent first (and, unfortunately, the last) manifestation of ischemia, pointing to the necessity of prospective and effective screening, best done by a screening‐MRI protocol, especially in young athletes. The 2 main causes of ischemic spells in ACAOS are 1. Baseline stenosis, featuring phasic and exercise‐related changes in lateral compression, inside the aortic tunica media, or intermittent spontaneous spasm of distal coronary segments. Conclusions CAAs are recently more frequently discovered by modern imaging, a fact that demands a prospective work up protocol to select the cases for preventive interventions. Integration of similar observation with developmental studies suggests the need to especially focus on ACAOS anomalies to better understand morphogenesis of the abnormal and the nature of functional impairment. Support or Funding Information Kinder Foundation and Texas Heart Institute