Details

Autor(en) / Beteiligte

• Doan, Tam
• Zea-Vera, Rodrigo
• Agrawal, Hitesh
• Mery, Carlos M
• Masand, Prakash
• Reaves-O’Neal, Dana
• Noel, Cory
• Qureshi, Athar M
• Sexson Tejtel, Kristen
• Fraser, Charles D
• Molossi, Silvana M

Titel

Abstract 12621: Myocardial Ischemia is Common in Anomalous Aortic Origin Af a Coronary Artery With Intraseptal Course

Ist Teil von

• Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A12621-A12621

Ort / Verlag

by the American College of Cardiology Foundation and the American Heart Association, Inc

Erscheinungsjahr

2019

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• IntroductionAnomalous aortic origin of a coronary artery (AAOCA) with intraseptal course is considered a benign condition, although there have been case reports of myocardial ischemia, arrhythmia, and sudden cardiac death.HypothesisMyocardial ischemia is not uncommon in AAOCA with intraseptal course. The study was thus aimed to determine clinical presentation, myocardial perfusion upon provocative stress testing, and management of children with intraseptal AAOCA in a prospective cohort.MethodsPatients with intraseptal AAOCA were prospectively evaluated and managed using a standardized algorithm from 12/2012-05/2019. Stress nuclear imaging and/or magnetic resonance imaging were performed in patients 8.0 years old and/or symptoms of ischemia. Diastolic fractional flow reserve during dobutamine infusion (dFFRd) and/or instantaneous wave-free ratio (iFR) were performed in patients with perfusion deficits or high-risk features. The risks/benefits of exercise restriction and surgery were discussed.ResultsA total of 18 patients (female 6, 33.3%), who presented with no symptoms (10, 55.6%), non-exertional (4, 22.2%), and exertional symptoms (4, 22.2%), were enrolled at a median age of 12.4 years (0.3-15.9). Perfusion imaging was performed in 14/18 (77.8%) and was abnormal in 7/14 (50%); dFFRd/iFR was positive in 5/8 (62.5%) (Figures 1). All 4 patients with exertional symptoms and 3/10 (30%) with no or non-exertional symptoms had inducible hypoperfusion. Coronary artery bypass grafting was performed in a 4-year-old child; beta blocker and exercise restriction were recommended in 4 other patients deemed not suitable for surgery. One patient had non-exertional chest pain and 17 were symptom-free at a median follow-up of 2.5 years (0.2-7.1).ConclusionUp to 50% of patients with intraseptal AAOCA had inducible myocardial hypoperfusion during provocative testing, suggesting the natural history of intraseptal AAOCA may not be completely benign.