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Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Large Pediatric Cohort Medium-Term Outcomes.
Doan, Tam T; Sachdeva, Shagun; Bonilla-Ramirez, Carlos; Reaves-O'Neal, Dana L; Masand, Prakash; Mery, Carlos M; Binsalamah, Ziyad; Heinle, Jeffrey H; Molossi, Silvana.
Affiliation
  • Doan TT; Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.).
  • Sachdeva S; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children's Hospital, Houston.
  • Bonilla-Ramirez C; Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.).
  • Reaves-O'Neal DL; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children's Hospital, Houston.
  • Masand P; Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.).
  • Mery CM; Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.H.H.), Baylor College of Medicine, Texas Children's Hospital, Houston.
  • Binsalamah Z; Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.).
  • Heinle JH; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children's Hospital, Houston.
  • Molossi S; Coronary Artery Anomalies Program, Texas Children's Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.).
Circ Cardiovasc Interv ; 16(4): e012631, 2023 04.
Article in En | MEDLINE | ID: mdl-37071720
BACKGROUND: Anomalous aortic origin of a right coronary artery may cause myocardial ischemia and sudden death in the young. Data on myocardial ischemia or longitudinal outcomes are sparse in pediatric anomalous aortic origin of a right coronary artery population. METHODS: Patients <21 years with anomalous aortic origin of a right coronary artery were prospectively enrolled. Computerized tomography angiography defined morphology. Exercise stress test and stress perfusion imaging (sPI) were performed if >7 years or younger with concern for ischemia. High-risk features included intramural length, slit-like/hypoplastic ostium, exertional symptoms, or evidence of ischemia. RESULTS: A total of 220 patients (60% males) were enrolled December 2012 to April 2020 at a median age 11.4 years (interquartile range, 6.1-14.5), including 168 (76%) with no/nonexertional symptoms (group 1) and 52 (24%) with exertional chest pain/syncope (group 2). Computerized tomography angiography was available in 189/220 (86%), exercise stress test in 164/220 (75%), and sPI in 169/220 (77%). Exercise stress test was positive in 2/164 (1.2%) patients in group 1, both had positive sPI. Inducible ischemia (sPI) was detected in 11/120 (9%) in group 1 and 9/49 (18%) in group 2 (P=0.09). Intramural length was similar in patients with/without ischemia (5 [interquartile range, 4-7] versus 5 [interquartile range, 4-7] mm; P=0.65). Surgery was recommended in 56/220 (26%) patients with high-risk features. In 52 surgical patients (38 unroofing, 14 reimplantation), all subjects were alive and have returned to exercise at last median follow-up of 4.6 (interquartile range, 2.3-6.5) years. CONCLUSIONS: Anomalous aortic origin of a right coronary artery patients can present with inducible ischemia on sPI despite symptoms or intramural length. Exercise stress test is a poor predictor of ischemia and caution should be given to determine low-risk based solely on this assessment. All patients are alive at medium-term follow-up.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Artery Disease / Myocardial Ischemia / Coronary Vessel Anomalies Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Child / Female / Humans / Male Language: En Journal: Circ Cardiovasc Interv Journal subject: ANGIOLOGIA / CARDIOLOGIA Year: 2023 Document type: Article Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Artery Disease / Myocardial Ischemia / Coronary Vessel Anomalies Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Child / Female / Humans / Male Language: En Journal: Circ Cardiovasc Interv Journal subject: ANGIOLOGIA / CARDIOLOGIA Year: 2023 Document type: Article Country of publication: