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1.
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.
Cardiology ; 142(3): 175-179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31212301

RESUMO

Anomalies of the coronary arteries represent rare congenital disorders, which are characterized by a wide spectrum of clinical manifestations. Usually, they are asymptomatic, but sometimes they cause myocardial ischemia or sudden cardiac death. Here, we describe the case of a patient who suffered from angina. Coronary angiography revealed an ectopic origin of the left anterior descending coronary artery from the proximal trait of the right coronary artery and the left circumflex artery, originating from the left sinus; the whole coronary tree was free of atherosclerosis. To better define the coronary anatomy, we performed computed tomography angiography with a three-dimensional reconstruction. The patient was discharged from the clinic after 48 h under optimal medical treatment.


Assuntos
Angina Pectoris/etiologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Idoso , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Anomalias dos Vasos Coronários/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Imagem Tridimensional , Tomografia Computadorizada por Raios X
4.
Expert Rev Cardiovasc Ther ; 17(7): 497-510, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232618

RESUMO

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.


Assuntos
Anomalias dos Vasos Coronários/etiologia , Doenças Vasculares/congênito , Adulto , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Gerenciamento Clínico , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Recidiva , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia
8.
Int J Cardiol ; 281: 28-34, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30587416

RESUMO

OBJECTIVES: This paper reviews new findings in both embryology of coronary arteries and in clinical observations of coronary artery anomalies. FOCUS: Our presentation emphasizes studies based on: 1) newer methods of coronary development in animals and humans, and 2) intravascular ultrasonography to interpret pathophysiology and guide treatment of coronary anomalies. CONCLUSIONS: New data reveal the roles of many cellular interactions and signaling pathways involved in the normal and abnormal formation of the coronary arterial system and the consequences of their defective formation. Pathogenetic developmental mechanisms include dysfunction of the Notch and Hypo signaling pathways, angiogenic and arteriogenic molecules, and neural crest cells. We addressed numerous clinically significant coronary anomalies and their prevalence in a general population (especially those characterized by an ectopic origin with aortic intramural course), and point out the critical relevance of understanding the variable mechanisms of coronary dysfunction, especially, fixed versus phasic stenoses or intermittent spasm, and individual severity of clinical presentations.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/fisiopatologia , Desenvolvimento Embrionário/fisiologia , Ultrassonografia de Intervenção/métodos , Animais , Vasos Coronários/anatomia & histologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Humanos
9.
Rev Recent Clin Trials ; 14(1): 41-46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30124159

RESUMO

BACKGROUND: Although not well established; gender may play a role in the incidence, clinical manifestations, and atherosclerotic burden of Coronary Artery Anomalies (CAAS). Our aim is to investigate the impact of gender on coronary artery anomalies. METHODS: All coronary angiograms performed at the University Heart Center Zurich, Switzerland, between January 2000 and December 2016 were investigated. Those of anomalous origin, course and termination (fistula) were included in the analysis with the exclusion of coronary artery aneurysms and myocardial bridges. RESULTS: Out of the original 39577 angiographic studies that included 28550 males and 11026 females, Coronary Artery Anomalies (CAAS) were documented in 130 (0.32%) patients of whom 69.2% (n=90) and 30.8%(n=40) were males and females respectively. However, the overall prevalence of coronary anomalies amongst both genders did not differ (0.32% vs 0.36%, P = 1) and so were the basic characteristics except for hypertension, which was more prevalent in females (P = 0.03644). The most prevalent anomaly overall was (left circumflex artery from right coronary artery/sinus), which was present in (n=47, 36.2%). No impact of gender on the incidence of individual anomalies except for Right Coronary Artery (RCA) originating from Left Circumflex Artery (LCX), which was only documented in men (P = 0.0000116). On the other hand malignant CAAS presented equally with a proportion of 10% for both genders (P = 1). Although males outnumbered females in terms of atherosclerotic burden in CAAS this was statistically not significant (P = 0.331). CONCLUSION: Both genders have a similar impact on the overall prevalence, clinical manifestations and atherosclerotic burden of CAAs. Anomaly of RCA originating from LCX occurred more frequently in males than females.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/epidemiologia , Idoso , Estudos de Coortes , Doença da Artéria Coronariana/fisiopatologia , Anomalias dos Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Taxa de Sobrevida
10.
J Cardiovasc Comput Tomogr ; 13(1): 75-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30366860

RESUMO

OBJECTIVE: To review the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on CT coronary angiography (CTCA) and evaluate its diagnostic performance compared with coronary catheter angiography (CCA) and transthoracic echocardiography (TTE). MATERIALS AND METHODS: We retrospectively reviewed with a diagnosis of CPAF from among 19855 consecutive CCTA performed with 256-slice MDCT scanner for suspected coronary artery disease. CT images were evaluated for - origin, number, size and course (tubular/worm-like dilation/significant aneurysm formation/wall attachment sign) of fistula vessels, drainage site, drainage site imaging features (pierced sign, isodensity sign, smoke sign, jet sign), and main pulmonary artery (MPA) enlargement. 25 patients of CPAF also underwent CCA and 47 patients underwent TTE. RESULTS: There were 72 patients with CPAF (0.36%) in our study, of which 44 were men and 28 were women, with mean age of 55.8 ±â€¯13.2 years (range 22-85 years). CPAF originated from conus artery, left anterior descending artery (LAD), combined conus artery and LAD in 55, 67, 50 cases, respectively. Tubular dilation, worm-like dilation and aneurysm was seen in 14, 58 and 35 cases, respectively. Wall attachment sign was noted in 69 cases. All the cases demonstrated only a single drainage site, with left lateral wall, left anterolateral, anterior, right lateral and right anterolateral walls of MPA in 44, 21, 5, 1 and 1 cases, respectively. The mean diameter of the fistula drainage site was 2.6 ±â€¯1.3 mm. Pierced sign, jet sign, smoke sign, isodensity sign was seen in 72, 46, 41 and 24 cases, respectively. MPA enlargement was seen in 20 patients. CCA showed CPAF in only 20 cases among 25 patients; while TTE showed CPAF in only 9 patients among 47 patients. CONCLUSION: CTCA is competent in detecting and characterizing CPAF with an excellent diagnostic performance as the first imaging modality of choice, which is valuable for giving a distinct and intuitive explanation to patients and physicians and making an objective and exact assessment for further management.


Assuntos
Fístula Artério-Arterial/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia/métodos , Tomografia Computadorizada Multidetectores/métodos , Artéria Pulmonar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Fístula Artério-Arterial/fisiopatologia , Circulação Coronária , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/anormalidades , Artéria Pulmonar/fisiopatologia , Circulação Pulmonar , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
12.
BMJ Case Rep ; 11(1)2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30567277

RESUMO

Single coronary artery (SCA) is a very rare coronary anomaly. The accurate diagnosis of the entity requires multimodality imaging of the coronary anatomy. SCA is often incidentally diagnosed when patients are investigated for symptoms of suspected coronary artery disease with invasive or non-invasive coronary angiography. There are no established diagnostic electrocardiographic or echocardiographic criteria to identify the presence of SCA, which makes the diagnosis a far-reaching fruit. We present a young male patient presenting with a non-ST elevation myocardial infarction. He was found to have SCA on invasive coronary angiography, which was subsequently confirmed by CT coronary angiography.


Assuntos
Angiografia Coronária , Doença da Artéria Coronariana/congênito , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Anomalias dos Vasos Coronários/fisiopatologia , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Sobrepeso , Educação de Pacientes como Assunto , Prevenção Secundária , Fumar , Resultado do Tratamento
14.
Cardiovasc Pathol ; 37: 45-53, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30342321

RESUMO

Myocardial damage in catecholamine cardiomyopathy, characterized by patchy myocyte necrosis commonly with contraction band appearances, interstitial fibrosis, and varying degrees of inflammatory infiltrates, has been well documented. However, coronary vascular pathology has not been recognized. Autopsy of a 43-year-old housewife who died of acute apical anteroseptal myocardial infarction revealed the incidental finding of a left adrenal pheochromocytoma. The epicardial and intramyocardial median- and small-sized coronary arteries exhibited myointimal dysplasia in the form of fibroblastic proliferation in the intima and media, resulting in thickened dysplastic vessels with marked luminal narrowing, occasionally leading to near-total occlusion. The distal left anterior descending artery showed features of recanalization after prior embolic occlusion. The density and severity of vascular involvement revealed a decreasing gradient from apical to basal region, mainly affecting the left ventricle, but the proximal coronary arteries were minimally affected. Myointimal dysplasia was not seen in control cases of hypertensive heart, and despite its presence in hearts with hypertrophic cardiomyopathy, it lacked the distinctive pattern of distribution and the epicardial vessels are uninvolved. Myointimal dysplasia probably results from reactive fibroplasia in response to the vasoconstrictive effect of circulating or local neurosecretory catecholamine and appears crucial in the pathogenesis of various types of catecholamine cardiomyopathy, including Takotsubo or stress cardiomyopathy. Together with the direct catecholamine cardiotoxicity, they result in diffuse microscopic ischemic necrosis and fibrosis. Depending on the type of catecholamine overproduction and action, together with the characteristic anatomic distribution and density of the various types of adrenergic receptors in the ventricles, different regions of the heart are variously affected so that different patterns of ventricular dysfunction are produced, with the subsequent angiographic appearances ranging from apical through midventricular to basal ballooning. Additional complications from the myointimal dysplasia include spontaneous coronary dissection, acute myocardial infarction, and superimposed thrombus formation in the dysplastic vessels and dyskinetic ventricle, with the risk of further damage from embolic events.


Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Anomalias dos Vasos Coronários/etiologia , Vasos Coronários/patologia , Infarto do Miocárdio/etiologia , Feocromocitoma/complicações , Cardiomiopatia de Takotsubo/etiologia , Doenças Vasculares/congênito , Neoplasias das Glândulas Suprarrenais/metabolismo , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Adulto , Autopsia , Catecolaminas/metabolismo , Anomalias dos Vasos Coronários/metabolismo , Anomalias dos Vasos Coronários/patologia , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/metabolismo , Evolução Fatal , Feminino , Fibrose , Humanos , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Miocárdio/metabolismo , Miocárdio/patologia , Necrose , Feocromocitoma/metabolismo , Feocromocitoma/patologia , Feocromocitoma/fisiopatologia , Cardiomiopatia de Takotsubo/metabolismo , Cardiomiopatia de Takotsubo/patologia , Cardiomiopatia de Takotsubo/fisiopatologia , Doenças Vasculares/etiologia , Doenças Vasculares/metabolismo , Doenças Vasculares/patologia , Doenças Vasculares/fisiopatologia , Função Ventricular Esquerda , Função Ventricular Direita , Remodelação Ventricular
15.
Circ Cardiovasc Interv ; 11(9): e006772, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30354594

RESUMO

BACKGROUND: Risks and mechanisms of extension of conservatively managed spontaneous coronary artery dissection (SCAD) remain incompletely understood. Study objectives were to (1) evaluate mechanisms of early SCAD evolution through serial angiographic analysis, and (2) determine predictors of early SCAD progression. METHODS AND RESULTS: Retrospective registry study of patients with SCAD managed with an initial conservative strategy (n=240). Patients who experienced significant SCAD progression within 14 days, defined as clinical worsening plus new critical coronary obstruction on repeat angiography, were compared with remaining controls. A total of 42 of 240 (17.5%) experienced significant SCAD progression after index conservative approach; 91% by day 6. Isolated intramural hematoma (IMH) at baseline (no intimal dissection) was observed more frequently in those experiencing progression compared with controls (69.1% versus 44.4%; P=0.004). Multivariable predictors of SCAD progression included lesion severity, multivessel involvement, and isolated IMH. To investigate mechanisms of SCAD evolution, all repeat angiograms ≤14 days were compared with corresponding baselines (n=82 patient angiogram pairs). Of those with isolated IMH at baseline, 20% developed intimal dissection at repeat study. IMH was associated with greater longitudinal lesion extension (11.5 versus 2.8 mm; P=0.01), worsening Thrombolysis in Myocardial Infarction flow (-0.8 versus 0.1; P=0.003), and a nonsignificant lower rate of angiographic improvement (20.0% versus 31.3%; P=0.16) compared with the group with baseline intimal dissection. Optical coherence tomography subgroup analysis (n=17) indicated intimo-medial thickness to be lowest at the midpoint of IMH. CONCLUSIONS: Conservatively managed SCAD carries a 1:6 hazard for serious deterioration within 6 days. The risk was higher in those with isolated IMH at baseline. IMH often precedes development of intimal dissection, which has implications for mechanisms of SCAD.


Assuntos
Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Doenças Vasculares/congênito , Adulto , Tratamento Conservador , Circulação Coronária , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/terapia , Vasos Coronários/fisiopatologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia , Doenças Vasculares/terapia
16.
J Emerg Med ; 55(4): e93-e96, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30166075

RESUMO

BACKGROUND: Anomalous coronary artery origins appear in roughly 1% of coronary angiograms, and up to 15% of syncope and sudden cardiac death events can be attributed to anomalous coronaries. Patients with an anomalous coronary artery arising from the opposite sinus may initially present with syncope and electrocardiographic findings of ischemia. CASE REPORT: We describe a case in which an adolescent male presented with exercise-induced angina and syncope, and his initial electrocardiogram (ECG) showed diffuse ST-segment depression with ST-segment elevation in lead aVR. Cardiac catheterization revealed there was no coronary ostium in the left coronary cusp, and the left coronary artery had an anomalous origin from the right cusp. The patient received urgent left internal mammary artery-to-left anterior descending artery coronary bypass and a saphenous vein graft to the ramus intermedius. After he underwent 6 months of medical therapy with ß-blockade and angiotensin-receptor blockade, his left ventricular systolic function improved to low-normal level (left ventricular ejection fraction, approximately 50%). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ST-segment elevation in lead aVR is strongly prognostic for left main or triple-vessel coronary artery disease. However, in patients who present with syncope and few other coronary artery disease risk factors, this ECG finding should be suggestive of an ischemic event caused by an anomalous left coronary artery. Early recognition of this pattern of clinical signs and ECG findings by an emergency physician could be critical for making the correct diagnosis and risk stratifying the patient for early coronary angiography and urgent surgical revascularization.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/anatomia & histologia , Exercício/fisiologia , Seio Aórtico/anormalidades , Adolescente , Traumatismos em Atletas/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/patologia , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Masculino , Seio Aórtico/anatomia & histologia , Seio Aórtico/fisiopatologia , Síncope/etiologia , Síncope/fisiopatologia
17.
Can J Cardiol ; 34(9): 1233.e5-1233.e8, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30170682

RESUMO

Congenital coronary artery disease (CAD) is commonly asymptomatic and often benign. Investigation of potential myocardial ischemia is also necessary. We report an original observation of abnormal origin and course of the right coronary artery (RCA), abnormal left main artery, and agenesis of the left anterior descending (LAD) artery. This is the first report of an association of 3 types of congenital coronary artery anomaly according to the modified Angelini's classification. This high-risk condition was successfully treated surgically.


Assuntos
Dor no Peito/diagnóstico , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Isquemia Miocárdica , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/congênito , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Diagnóstico Diferencial , Ecocardiografia , Teste de Esforço/métodos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/cirurgia , Resultado do Tratamento
18.
Can J Cardiol ; 34(9): 1233.e9-1233.e11, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30078692

RESUMO

Although most congenital coronary artery anomalies have no prognostic implications, associations with sudden cardiac death have been described, particularly in the young. We report an exercise-associated collapse in an otherwise asymptomatic middle-aged female marathoner. The aborted sudden cardiac death approach revealed an unexpected initial presentation of a malignant anomalous left main coronary artery origin, with ostial stenosis and interarterial course. The present case illustrates an unusually longstanding coexistence of a malignant anatomical variant with a persistent trigger.


Assuntos
Reanimação Cardiopulmonar/métodos , Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Vasos Coronários , Morte Súbita Cardíaca/etiologia , Procedimentos Cirúrgicos Vasculares/métodos , Ponte Cardiopulmonar/métodos , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Corrida , Resultado do Tratamento
19.
Semin Cardiothorac Vasc Anesth ; 22(4): 383-394, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30095030

RESUMO

The term "coronary artery anomalies" encompasses a large and heterogeneous group of disorders that may affect origin, intrinsic anatomy, course, location, and termination of the coronary arteries. With these different anatomies, presentation, symptoms, and outcomes are heterogeneous as well. While significant efforts are directed toward improving diagnosis and risk-stratification, best evidence-guided practices remain in evolution. Data about anesthetic management of patients with coronary anomalies are lacking as well. This review aims to provide the anesthesiologist with a better understanding of an important subgroup of coronary artery anomalies: anomalous aortic origin of a coronary artery. We will discuss classification, pathophysiology, incidence, evaluation, management, and anesthetic implications of this potentially fatal disease group.


Assuntos
Anestesia/métodos , Anestésicos/administração & dosagem , Anomalias dos Vasos Coronários/complicações , Anestesiologistas/organização & administração , Anestesiologia/métodos , Aorta/anormalidades , Anomalias dos Vasos Coronários/fisiopatologia , Humanos
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