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1.
Curr Opin Cardiol ; 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31633566

RESUMO

PURPOSE OF REVIEW: To report what is known and unknown regarding coronary anomalies in children, particularly anomalous aortic origin of a coronary artery, efforts undertaken to answer several questions regarding evaluation and management of this challenging young population, and where the future is heading. RECENT FINDINGS: Patients with anomalous aortic origin of a coronary artery (AAOCA) present as an incidental finding at least half of the time, advanced imaging is essential to define anatomic characteristics of this lesion, assessment of myocardial perfusion with stress cardiac magnetic resonance imaging is feasible and contributes to risk stratification, certain patient populations require invasive assessment of coronary flow with measurement of fractional flow reserve, and surgical intervention can be safely performed through long-term data on impact to prevent sudden events is lacking. SUMMARY: Optimal risk stratification in AAOCA is yet to be defined, though substantial strides are being made with a standardized approach to the evaluation and management of these patients. Continued collaboration among centers and the scientific community will positively impact patients and families living with AAOCA.

2.
Methodist Debakey Cardiovasc J ; 15(2): 111-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384374

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.


Assuntos
Técnicas de Imagem Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Tomada de Decisão Clínica , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
3.
J Thorac Cardiovasc Surg ; 158(3): 822-834.e3, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31235351

RESUMO

OBJECTIVES: We sought to determine anatomic features associated with evidence of myocardial ischemia and sudden cardiac events (arrest or death) for patients with anomalous aortic origin of a coronary artery. METHODS: We enrolled 560 patients, less than or equal to 30 years, at diagnosis from 40 institutions. Ischemia was defined as the presence of exertional syncope, a sudden cardiac event (arrest/death), or abnormal investigation results. Data on detailed anatomic features were abstracted from echocardiography, computed tomography, magnetic resonance imaging, operative, and/or surgeon-completed reports. RESULTS: There were 236 patients with negative ischemia test results, and 49 with evidence of ischemia (including 18 who presented with a sudden cardiac event); 275 asymptomatic patients who had not undergone provocative ischemia testing were excluded from primary analyses. Patients with ischemia (vs without), were more likely to have left anomalous coronary arteries (28/49 vs 46/236; P < .0001). Of patients with ischemia (vs without), those with anomalous left coronary arteries were more likely to have an intramural coronary artery course, or a high or slit-like coronary artery orifice. Of patients with ischemia (vs without), those with anomalous right coronary arteries were more likely to have a longer intramural course. Among patients with ischemia, the occurrence of sudden cardiac events was not shown to have any associated anatomic features. CONCLUSIONS: Anatomic features including coronary artery involved, intramural course and length, and orifice anomalies were associated with evidence of myocardial ischemia for patients with anomalous aortic origin of a coronary artery. These features might importantly inform risk stratification and decisions regarding surgical management.

4.
Cardiol Young ; 28(9): 1099-1105, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30001755

RESUMO

BACKGROUND: Anomalous aortic origin of a coronary artery is the second leading cause of sudden cardiac arrest/death in young athletes in the United States of America. Limited data are available regarding family history in this patient population. METHODS: Patients were evaluated prospectively from 12/2012 to 02/2017 in the Coronary Anomalies Program at Texas Children's Hospital. Relevant family history included the presence of CHD, sudden cardiac arrest/death, arrhythmia/pacemaker use, cardiomyopathy, and atherosclerotic coronary artery disease before the age of 50 years. The presence of one or more of these in 1st- or 2nd-degree relatives was considered significant. RESULTS: Of 168 unrelated probands (171 patients total) included, 36 (21%) had significant family history involving 19 (53%) 1st-degree and 17 (47%) 2nd-degree relatives. Positive family history led to cardiology referral in nine (5%) patients and the presence of abnormal tests/symptoms in the remaining patients. Coronary anomalies in probands with positive family history were anomalous right (27), anomalous left (five), single right coronary artery (two), myocardial bridge (one), and anomalous circumflex coronary artery (one). Conditions present in their family members included sudden cardiac arrest/death (15, 42%), atherosclerotic coronary artery disease (14, 39%), cardiomyopathy (12, 33%), CHD (11, 31%), coronary anomalies (3, 8%), myocardial bridge (1, 3%), long-QT syndrome (2, 6%), and Wolff-Parkinson-White (1, 3%). CONCLUSION: In patients with anomalous aortic origin of a coronary artery and/or myocardial bridges, there appears to be familial clustering of cardiac diseases in approximately 20% of patients, half of these with early occurrence of sudden cardiac arrest/death in the family.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Morte Súbita Cardíaca/epidemiologia , Medição de Risco/métodos , Seio Aórtico/anormalidades , Adolescente , Criança , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/epidemiologia , Morte Súbita Cardíaca/etiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Prospectivos , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Estados Unidos/epidemiologia
6.
Am Heart J ; 202: 104-108, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29920452

RESUMO

Sudden cardiac death in the young (SCDY) spans gender, race, ethnicity, and socioeconomic class. The loss of any pediatric patient is a matter of national and international public health concern, and focused efforts should be aimed at preventing these burdensome tragedies. Prepared by members of the Cardiac Safety Research Consortium, this White Paper summarizes and reports the dialogue at the second Think Tank related to the issues and the proposed solutions for the development of a national resource for screening and prevention of SCDY. This Think Tank, sponsored by the Cardiac Safety Research Consortium and the United States Food and Drug Administration, convened on February 18, 2016, in Miami, FL, to identify and resolve the barriers that prevent early identification of patients at risk for SCDY. All potential stakeholders including national and international experts from industry, medicine, academics, engineering, and community advocacy leaders had an opportunity to share ideas and collaborate.

8.
Eur Heart J ; 39(16): 1466-1480, 2018 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-28329355

RESUMO

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

9.
J Thorac Cardiovasc Surg ; 155(1): 305-319.e4, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29074047

RESUMO

OBJECTIVE: The purpose of this study was to prospectively analyze the outcomes of patients with anomalous aortic origin of a coronary artery undergoing surgical intervention according to a standardized management algorithm. METHODS: All patients aged 2 to 18 years undergoing surgical intervention for anomalous aortic origin of a coronary artery between December 2012 and April 2017 were prospectively included. Patients underwent stress nuclear perfusion imaging, stress cardiac magnetic resonance imaging, and retrospectively electrocardiogram-gated computed tomography angiography preoperatively. Patients were cleared for exercise at 3 months postoperatively if asymptomatic and repeat stress nuclear perfusion imaging, stress cardiac magnetic resonance imaging, and computed tomography angiography showed normal results. RESULTS: A total of 44 patients, with a median age of 14 years (8-18 years), underwent surgical intervention: 9 (20%) for the anomalous left coronary artery and 35 (80%) for the anomalous right coronary artery. Surgical procedures included unroofing in 35 patients (80%), translocation in 7 patients (16%), ostioplasty in 1 patient (2%), and side-side-anastomosis in 1 patient (2%). One patient who presented with aborted sudden cardiac death from an anomalous left coronary and underwent unroofing presented 1 year later with a recurrent episode and was found to have an unrecognized myocardial bridge and persistent compression of the coronary requiring reintervention. At last follow-up, 40 patients (91%) are asymptomatic and 4 patients have nonspecific chest pain; 42 patients (95%) have returned to full activity, and 2 patients are awaiting clearance. CONCLUSIONS: Surgical treatment for anomalous aortic origin of a coronary artery is safe and should aim to associate the coronary ostium with the correct sinus, away from the intercoronary pillar. After surgery, the majority of patients are cleared for exercise and remain asymptomatic. Longer follow-up is needed to assess the true efficacy of surgery in the prevention of sudden cardiac death.

10.
J Am Coll Cardiol ; 70(15): 1902-1918, 2017 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-28982505

RESUMO

The last few decades have seen substantial growth in the populations of competitive athletes and highly active people (CAHAP). Although vigorous physical exercise is an effective way to reduce the risk of cardiovascular (CV) disease, CAHAP remain susceptible to inherited and acquired CV disease, and may be most at risk for adverse CV outcomes during intense physical activity. Traditionally, multidisciplinary teams comprising athletic trainers, physical therapists, primary care sports medicine physicians, and orthopedic surgeons have provided clinical care for CAHAP. However, there is increasing recognition that a care team including qualified CV specialists optimizes care delivery for CAHAP. In recognition of the increasing demand for CV specialists competent in the care of CAHAP, the American College of Cardiology has recently established a Sports and Exercise Council. An important primary objective of this council is to define the essential skills necessary to practice effective sports cardiology.


Assuntos
Cardiologia , Cardiomegalia Induzida por Exercícios/fisiologia , Doenças Cardiovasculares , Exercício/fisiologia , Serviços Preventivos de Saúde , Medicina Esportiva , Esportes/fisiologia , Atletas , Cardiologia/educação , Cardiologia/métodos , Cardiologia/normas , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Competência Clínica , Currículo/tendências , Assistência à Saúde/tendências , Humanos , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Melhoria de Qualidade , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Medicina Esportiva/educação , Medicina Esportiva/métodos , Medicina Esportiva/normas , Estados Unidos/epidemiologia
11.
Ann Thorac Surg ; 104(3): e265-e267, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28838524

RESUMO

We describe a patient with anomalous left coronary artery with a short intramural course and a previously unrecognized myocardial bridge who presented with a recurrent episode of aborted sudden cardiac death. Intravascular ultrasound and fractional flow reserve showed significant compression at the left coronary artery ostium by the intercoronary pillar and at the myocardial bridge. Intravascular ultrasound and fractional flow reserve were normal after coronary translocation and unroofing of the myocardial bridge. All potential anatomic culprits should be addressed when operating on patients with anomalous coronaries.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Criança , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/complicações , Morte Súbita Cardíaca/patologia , Humanos , Masculino
12.
Am Heart J ; 190: 123-131, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28760206

RESUMO

This White Paper, prepared by members of the Cardiac Safety Research Consortium, discusses important issues regarding sudden cardiac death in the young (SCDY), a problem that does not discriminate by gender, race, ethnicity, education, socioeconomic level, or athletic status. The occurrence of SCDY has devastating impact on families and communities. Sudden cardiac death in the young is a matter of national and international public health, and its prevention has generated deep interest from multiple stakeholders, including families who have lost children, advocacy groups, academicians, regulators, and the medical industry. To promote scientific and clinical discussion of SCDY prevention and to germinate future initiatives to move this field forward, a Cardiac Safety Research Consortium-sponsored Think Tank was held on February 21, 2015 at the US Food and Drug Administration's White Oak facilities, Silver Spring, MD. The ultimate goal of the Think Tank was to spark initiatives that lead to the development of a rational, reliable, and sustainable national health care resource focused on SCDY prevention. This article provides a detailed summary of discussions at the Think Tank and descriptions of related multistakeholder initiatives now underway: it does not represent regulatory guidance.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Recursos em Saúde/organização & administração , Vigilância da População/métodos , Pesquisa Qualitativa , Morte Súbita Cardíaca/epidemiologia , Humanos , Incidência , Estados Unidos/epidemiologia , Adulto Jovem
13.
Congenit Heart Dis ; 12(5): 610-614, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28670826

RESUMO

BACKGROUND: Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes in the USA. Long-term outcome data for these patients are lacking to date. There is insufficient knowledge on the best approach to these patients and they are managed in a nonuniform manner. METHODS: An online survey of 15 questions regarding management of AAOCA was sent out to 198 cardiac healthcare providers. The goal was to define gaps in knowledge to justify a dedicated scientific forum for discussion of AAOCA. Descriptive statistics were performed. RESULTS: A total of 91 providers (46%) completed the survey including pediatric cardiology subspecialists (40%), general pediatric cardiologists (24%), cardiovascular (CV) surgeons (22%), adult cardiologists (10%), nurse practitioners (8%), cardiology fellows (3%) and CV anesthesiologist (1%). Forty-eight percent had been practicing for over 15 years and 28% were in their first 5 years of practice. Fifty-two percent of the providers cared for adults and 93% cared for children/adolescents. Eighty-eight percent were affiliated with an academic institution. All but one provider practiced in the USA, 62% practiced in Texas. Half of participants (50%) were very comfortable managing AAOCA patients and 36% were somewhat comfortable. Providers utilized various imaging tests to confirm the anatomy including computed tomography angiography 88%, cardiac magnetic resonance imaging 70%, cardiac catheterization 60%, echocardiogram 12%, IVUS 2% and myocardial perfusion scan 1%. The majority felt comfortable in counseling the families and felt that depending on the type of lesion these patients should get surgical referral (85%) vs clinical follow up (67%) with exercise restriction (65%). CONCLUSION: There is heterogeneity in the way AAOCA patients are currently evaluated and managed. A knowledge gap exists even with participants from academic institutions. Long-term data with a defined approach to management of these patients may help to improve outcomes and prevent unnecessary exercise restriction or surgery.


Assuntos
Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Gerenciamento Clínico , Inquéritos e Questionários , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Cateterismo Cardíaco , Criança , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Feminino , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Estudos Retrospectivos
14.
Congenit Heart Dis ; 12(5): 603-606, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28737022

RESUMO

Anomalous aortic origin of a coronary artery is a congenital abnormality of the origin or course of a coronary artery that arises from the aorta. As commonly seen in congenital heart disease, a wide spectrum of anatomic variability is seen and hence, it is important for clinicians to document the precise anatomy and course of the anomalous vessel. This article describes coronary artery nomenclature using computerized tomography angiography and virtual angioscopy. These details are important for decision making, useful for surgical planning, and may have prognostic implications.


Assuntos
Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários , Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Aorta Torácica/diagnóstico por imagem , Criança , Anomalias dos Vasos Coronários/classificação , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/epidemiologia , Saúde Global , Humanos , Incidência , Prognóstico
15.
Congenit Heart Dis ; 12(5): 607-609, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28621042

RESUMO

The clinical evaluation of patients with an anomalous aortic origin of a coronary artery (AAOCA), a congenital abnormality of the origin or course of a coronary artery that arises from the aorta, is challenging given its first presentation being sudden cardiac arrest in about half of the patients. Symptoms of chest pain, shortness of breath and syncope during exertion should be of concern in evaluating young athletes and nonathletes. The lack of abnormal signs on the physical exam and electrocardiogram further adds to the difficulty in establishing the diagnosis. Additional imaging with echocardiography, computed tomography angiography and/or cardiac magnetic resonance imaging (MRI) is often needed and establishes the diagnosis. High-risk lesions include origin of the coronary artery from the opposite sinus of Valsalva, intramural course and ostial abnormalities (stenosis, hypoplasia). Functional studies should be performed to assess myocardial perfusion at rest and during stress, such as nuclear imaging, stress echocardiography and stress cardiac MRI.


Assuntos
Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Teste de Esforço , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X
16.
Congenit Heart Dis ; 12(5): 596, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28643441

RESUMO

Coronary artery anomalies, particularly anomalous aortic origin of a coronary artery with an interarterial course, are associated with sudden cardiac arrest or death in the young. There is paucity of data on risk stratification and longitudinal follow up is lacking in these patients. Collaboration and sharing of data among specialized centers might shed much needed light in this complex problem.


Assuntos
Anomalias dos Vasos Coronários , Procedimentos Cirúrgicos Vasculares , Criança , Congressos como Assunto , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/epidemiologia , Anomalias dos Vasos Coronários/cirurgia , Humanos , Incidência , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
17.
Congenit Heart Dis ; 12(6): 721-725, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28493446

RESUMO

BACKGROUND: Long-term outcome data on patients with anomalous aortic origin of coronary arteries (AAOCA) is sparse and they are often managed in a nonuniform manner. There is subjective perception of anxiety and unmet needs in these patients and families. METHODS: An online survey of 13 questions was sent to 74 families of patients with AAOCA between May and October 2015. Descriptive statistics were performed. RESULTS: A total of 31 (47%) families responded. Of these, 27 expressed the need to interact with other patients/families with AAOCA. The majority were interested in either face-to-face meetings (77%) or online support groups (71%). Regarding content of the meeting, 74% were interested in brief talks by medical personnel/families, 58% suggested informal interactions with families, 55% proposed a structured discussion with a moderator and 39% mentioned fun activities/games. Regarding participants in these meetings, 90% would like to include healthcare providers, 61% suggested including family friends, 58% wished to include psychologists and 16% mentioned including social workers. The families currently use various social media including Facebook (87%), YouTube (39%), Google+ (36%), and LinkedIn (32%). For future online resources, 77% of families would like a Facebook site, an informative website (58%), a blog (52%), or an open forum (29%). The majority of the families (77%) were interested in attending a dedicated AAOCA meeting. CONCLUSION: There appears to be an unmet need for family support in those affected by AAOCA, a substantial life changing diagnosis for patients and families. Further research is needed to assess quality of life in this population.


Assuntos
Anomalias dos Vasos Coronários/psicologia , Família/psicologia , Determinação de Necessidades de Cuidados de Saúde , Inquéritos e Questionários , Criança , Anomalias dos Vasos Coronários/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo
18.
Br J Sports Med ; 51(9): 704-731, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28258178

RESUMO

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/normas , Cardiopatias/diagnóstico , Medicina Esportiva/normas , Adolescente , Adulto , Atletas , Criança , Consenso , Humanos , Programas de Rastreamento , Washington , Adulto Jovem
19.
J Am Coll Cardiol ; 69(8): 1057-1075, 2017 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-28231933

RESUMO

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On February 26-27, 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.


Assuntos
Arritmias Cardíacas/diagnóstico , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/normas , Medicina Esportiva , Adolescente , Adulto , Fatores Etários , Arritmias Cardíacas/complicações , Criança , Humanos , Adulto Jovem
20.
Pediatr Cardiol ; 38(3): 624-630, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28214966

RESUMO

The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children's Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12-4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6-18.7) years and median weight 49.5 (11.4-142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.


Assuntos
Aorta Torácica/diagnóstico por imagem , Cateterismo Cardíaco , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Ponte Miocárdica/terapia , Ultrassonografia de Intervenção , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos , Medição de Risco , Texas
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