Clinical Analysis of Sixty-nine Children with Anomalous Aortic Origin of the Coronary Artery

Overview

Journal Eur J Pediatr

Specialty Pediatrics

Date 2023 Jul 12

PMID 37436520

Authors

Zhen Zhen

Ziyan Dong

Jia Na

Xi Chen

Qirui Li

Lu Gao

Yue Yuan

Affiliations

Soon will be listed here.

Abstract

We aimed to analyse the clinical characteristics of children with different types of anomalous aortic origin of the coronary artery (AAOCA) at different ages, and to discuss the factors related to myocardial ischaemia. In this retrospective study, we included 69 children diagnosed with AAOCA using CT coronary angiography; we classified the participants based on the type of AAOCA, age, and high-risk anatomy. The clinical characteristics of the different AAOCA types and age groups were compared, and the correlation between manifestations and high-risk anatomy was analysed. Anomalous origin of the left coronary artery from the right coronary artery sinus, anomalous origin of the right coronary artery from the left coronary artery sinus, and a coronary artery origin without coronary sinuses was found in 10 (14.5%), 57 (82.6%), 2 (2.9%) patients, respectively. There were no significant differences in sex, clinical manifestations, percentage of positive myocardial injury markers, electrocardiogram, transthoracic echocardiography, or proportion of high-risk anatomy among the groups with different AAOCA types. According to age group, the proportion of asymptomatic infants and pre-schoolers was the highest (p < 0.001). Forty-three patients (62.3%) had high-risk anatomy and were more likely to present with severe symptoms and cardiac syncope (p < 0.05). Conclusion: There were no significant differences in the proportions of high-risk anatomy and clinical characteristics among children with different AAOCA types. We found a relation between the severity of AAOCA clinical symptoms and anatomical risk. What is Known: • Clinical symptoms in children with AAOCA are varied and the results of routine cardiological examinations lack specificity. • High-risk anatomical features, exercise, cardiac symptoms, and ALCA are risk factors for the occurrence of SCD in patients with AAOCA. What is New: • Compared the clinical characteristics of different types of AAOCA and ages. • Analysed the correlation between symptoms and high-risk anatomical features.

References

Angelini P, Cheong B, Lenge De Rosen V, Lopez J, Uribe C, Masso A . Magnetic Resonance Imaging-Based Screening Study in a General Population of Adolescents. J Am Coll Cardiol. 2018; 71(5):579-580. DOI: 10.1016/j.jacc.2017.11.051. View

Finocchiaro G, Behr E, Tanzarella G, Papadakis M, Malhotra A, Dhutia H . Anomalous Coronary Artery Origin and Sudden Cardiac Death: Clinical and Pathological Insights From a National Pathology Registry. JACC Clin Electrophysiol. 2019; 5(4):516-522. DOI: 10.1016/j.jacep.2018.11.015. View

Molossi S, Agrawal H, Mery C, Krishnamurthy R, Masand P, Sexson Tejtel S . Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach. Circ Cardiovasc Interv. 2020; 13(2):e008445. DOI: 10.1161/CIRCINTERVENTIONS.119.008445. View

Doan T, Sachdeva S, Bonilla-Ramirez C, Reaves-ONeal D, Masand P, Krishnamurthy R . Anomalous Aortic Origin of Coronary Arteries in Children: Postoperative High-risk Anatomic Features. Ann Thorac Surg. 2022; 115(4):991-998. DOI: 10.1016/j.athoracsur.2022.11.024. View

Stout K, Daniels C, Aboulhosn J, Bozkurt B, Broberg C, Colman J . 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 73(12):1494-1563. DOI: 10.1016/j.jacc.2018.08.1028. View

Krupinski M, Urbanczyk-Zawadzka M, Laskowicz B, Irzyk M, Banys R, Klimeczek P . Anomalous origin of the coronary artery from the wrong coronary sinus evaluated with computed tomography: "high-risk" anatomy and its clinical relevance. Eur Radiol. 2014; 24(10):2353-9. DOI: 10.1007/s00330-014-3238-2. View

Bigler M, Kadner A, Raber L, Ashraf A, Windecker S, Siepe M . Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing. J Am Heart Assoc. 2022; 11(20):e027098. PMC: 9673667. DOI: 10.1161/JAHA.122.027098. View

Brothers J, Gaynor J, Jacobs J, Poynter J, Jacobs M . The Congenital Heart Surgeons' Society Registry of Anomalous Aortic Origin of a Coronary Artery: an update. Cardiol Young. 2015; 25(8):1567-71. DOI: 10.1017/S1047951115002061. View

Doshi A, Opfer E, Forsha D . Anomalous aortic origin of the right coronary artery from the non-coronary sinus of Valsalva. Cardiol Young. 2019; 29(4):531-533. DOI: 10.1017/S1047951119000039. View

10.

Krishnamurthy R, Masand P, Jadhav S, Molossi S, Zhang W, Agrawal H . Accuracy of computed tomography angiography and structured reporting of high-risk morphology in anomalous aortic origin of coronary artery: comparison with surgery. Pediatr Radiol. 2021; 51(8):1299-1310. DOI: 10.1007/s00247-021-05011-0. View

11.

Balasubramanya S, Monge M, Eltayeb O, Sarwark A, Costello J, Rigsby C . Anomalous Aortic Origin of a Coronary Artery: Symptoms Do Not Correlate With Intramural Length or Ostial Diameter. World J Pediatr Congenit Heart Surg. 2017; 8(4):445-452. DOI: 10.1177/2150135117710926. View

12.

Graidis C, Dimitriadis D, Karasavvidis V, Dimitriadis G, Argyropoulou E, Economou F . Prevalence and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease. BMC Cardiovasc Disord. 2015; 15:112. PMC: 4592552. DOI: 10.1186/s12872-015-0098-x. View

13.

Padalino M, Franchetti N, Sarris G, Hazekamp M, Carrel T, Frigiola A . Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. Int J Cardiol. 2019; 291:189-193. DOI: 10.1016/j.ijcard.2019.02.007. View

14.

Bigler M, Ashraf A, Seiler C, Praz F, Ueki Y, Windecker S . Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence. Front Cardiovasc Med. 2021; 7:591326. PMC: 7859106. DOI: 10.3389/fcvm.2020.591326. View

15.

Sirasapalli C, Christopher J, Ravilla V . Prevalence and spectrum of coronary artery anomalies in 8021 patients: A single center study in South India. Indian Heart J. 2018; 70(6):852-856. PMC: 6306341. DOI: 10.1016/j.ihj.2018.01.035. View

16.

Chaosuwannakit N, Makarawate P . Diagnosis and prognostic significance of anomalous origin of coronary artery from the opposite sinus of Valsalva assess by dual-source coronary computed tomography angiography. Int J Cardiol Heart Vasc. 2021; 32:100723. PMC: 7851334. DOI: 10.1016/j.ijcha.2021.100723. View

17.

Kurosu A, Kuroyanagi K, Yamauchi S, Omura K, Saito K . Sudden Death Caused by Anomalous Origin of the Coronary Artery During Exercise. J Forensic Sci. 2016; 61(2):548-550. DOI: 10.1111/1556-4029.13004. View

18.

Brothers J, Frommelt M, Jaquiss R, Myerburg R, Fraser Jr C, Tweddell J . Expert consensus guidelines: Anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg. 2017; 153(6):1440-1457. DOI: 10.1016/j.jtcvs.2016.06.066. View

19.

Sachdeva S, Frommelt M, Mitchell M, Tweddell J, Frommelt P . Surgical unroofing of intramural anomalous aortic origin of a coronary artery in pediatric patients: Single-center perspective. J Thorac Cardiovasc Surg. 2017; 155(4):1760-1768. DOI: 10.1016/j.jtcvs.2017.11.003. View

20.

Mery C, Lopez K, Molossi S, Sexson-Tejtel S, Krishnamurthy R, McKenzie E . Decision analysis to define the optimal management of athletes with anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg. 2016; 152(5):1366-1375.e7. DOI: 10.1016/j.jtcvs.2016.07.076. View