Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

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Anomalous Origin of the Right Coronary Artery With Interarterial Course: Red Flag or Innocent Bystander?

10.21203/rs.3.rs-558192/v1 ◽

2021 ◽

Author(s):

Francisco Albuquerque ◽

Pedro De Araújo Gonçalves ◽

Hugo Marques ◽

António M. Ferreira ◽

Pedro Freitas ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Right Coronary Artery ◽

Suspected Coronary Artery Disease ◽

Anomalous Origin ◽

Cardiac Symptoms ◽

Asymptomatic Patients ◽

Increased Risk ◽

The Right

Abstract Purpose: Anomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increasing recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD).Methods: We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Right-ACAOS with IAC patients were analyzed for cardiac symptoms and long-term occurrence of first MACE (SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Results: Among 10928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented with stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no CV deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel.Conclusions: Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

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Anomalous origin of the right coronary artery with interarterial course: red flag or innocent bystander?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.019 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

F Albuquerque ◽

P De Araujo Goncalves ◽

H Marques ◽

A Ferreira ◽

P Freitas ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Right Coronary Artery ◽

Anomalous Origin ◽

Long Term Outcomes ◽

Cardiac Symptoms ◽

Increased Risk ◽

The Right

Abstract Funding Acknowledgements Type of funding sources: None. Background Anomalous origin of the right coronary artery (right ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomographic angiography (CCTA) has led to increasing recognition of this condition, even among healthy individuals. This study sought to examine the prevalence, anatomical characteristics and outcomes of right ACAOS with IAC in patients undergoing CCTA for all-indications. Methods We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital between January 2012 and December 2020. Right ACAOS patients with IAC were analyzed for cardiac symptoms (anginal chest pain, syncope, aborted SCD) and long-term outcomes were evaluated for myocardial infarction, ischemic test results, revascularization procedures and all-cause or cardiovascular (CV) mortality. CCTAs were reviewed for proposed high-risk features (ie., take-off angle, length and severity of proximal narrowing, intramural course, interarterial length) and concomitant coronary artery disease (CAD). Association between high-risk features was analyzed. Long-term outcomes were evaluated. Results Among 10,928 patients referred for CCTA during the study period, we identified 28 patients (0.3% prevalence) with right ACAOS and IAC. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented cardiac symptoms. During a median follow-up of 44.1 ± 31.8 months, there were no CV deaths and only 1 patient (3.65%) underwent surgical revascularization. Baseline characteristics and CCTA findings are presented in figure 1. Conclusion Right ACAOS and IAC is an uncommon finding, with an observed prevalence of 0.3%. CCTA provides excellent anatomical characterization of anomalous vessels, including suggested high-risk features. In a population of asymptomatic patients who survived this condition well into adulthood, the risk of events was very low and medical follow up might be a reasonable option.

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Anomalous Origin of Right Coronary Artery From Left Coronary Sinus—13 Cases Treated With the Reimplantation Technique

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116688172 ◽

2017 ◽

Vol 8 (3) ◽

pp. 315-320 ◽

Cited By ~ 5

Author(s):

Alain Cubero ◽

Alejandro Crespo ◽

Gadah Hamzeh ◽

Andrés Cortes ◽

Daniel Rivas ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Right Coronary Artery ◽

Anomalous Origin ◽

Atypical Chest Pain ◽

Asymptomatic Patients ◽

Clinically Significant ◽

Artery Disease ◽

The Right

Objectives: Anomalous aortic origin of a coronary artery is uncommon but potentially clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe our experience with surgical reimplantation and results at midterm follow-up. Methods: Between February 2003 and July 2016, a total of 13 patients with anomalous origin of the right coronary artery (RCA) from the left sinus underwent surgical reimplantation. Results: Mean age was 39 years (range, 11-72 years). Eight patients presented with dyspnea and angina, two with acute myocardial infarction, and the remaining three were studied for atypical chest pain and ventricular premature contractions. Definitive diagnosis was achieved with coronary angiography in eight cases and with computed tomography scan in five. In all cases, the anomalous origin of the RCA from the left sinus had an intramural course except one case with interarterial (but not intramural) course. At operation, the RCA was dissected at the takeoff from the intramural course and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated atherosclerotic coronary artery disease that required stent placement postoperatively. After a mean follow-up of 65 months (maximum 12 years), all patients are asymptomatic and have returned to exercise without limitations. Conclusions: The reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives similar results to the unroofing technique.

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Life-saving myocarditis? A case in a young adult leading to discovery of an anomalous origin of the right coronary artery

Cardiology in the Young ◽

10.1017/s1047951120002279 ◽

2020 ◽

Vol 30 (10) ◽

pp. 1510-1511

Author(s):

Rachel Rosenthal ◽

Hannah Obasi ◽

Daniel D. Im

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Right Coronary Artery ◽

Cardiac Death ◽

Anomalous Origin ◽

Coronary Artery Anomalies ◽

Life Saving ◽

Life Threatening ◽

The Right ◽

Anomalous Coronary

AbstractMyocarditis and coronary artery anomalies are both potentially life-threatening aetiologies of cardiac chest pain in children. We present a case of a young man presenting with non-exertional chest pain and subsequently found to have an anomalous origin of the right coronary artery from the left coronary sinus with an interarterial course in addition to a diagnosis of myocarditis. The patient subsequently was able to undergo surgical correction of his anomalous coronary to mitigate the risk of sudden cardiac death.

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Repeated Aborted Sudden Cardiac Death with Long QT Syndrome in a Patient with Anomalous Origin of the Right Coronary Artery from the Left Coronary Cusp

Korean Circulation Journal ◽

10.4070/kcj.2013.43.12.830 ◽

2013 ◽

Vol 43 (12) ◽

pp. 830 ◽

Cited By ~ 3

Author(s):

Yae Min Park ◽

Su Ji Kim ◽

Chul-Hyun Park ◽

Woong Chol Kang ◽

Mi-Seung Shin ◽

...

Keyword(s):

Coronary Artery ◽

Sudden Cardiac Death ◽

Right Coronary Artery ◽

Long Qt Syndrome ◽

Cardiac Death ◽

Anomalous Origin ◽

Long Qt ◽

Qt Syndrome ◽

Coronary Cusp ◽

The Right

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Association of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery with Aortopulmonary Window. Two case report

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.05.06.05 ◽

2020 ◽

Vol 5 (6) ◽

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Coronary Flow ◽

Anomalous Origin ◽

Congenital Defects ◽

Aortopulmonary Window ◽

Rare Entity ◽

Asymptomatic Patients ◽

The Right

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare entity. Brooks described first cases in 1885. Only 25% to 30% % of cases are associated with congenital defects such as aortopulmonary window and tetralogy of Fallot. It is recommended the reimplantation of the right coronary artery in the Aorta, with redistribution of coronary flow avoiding the signs of ischemia or other complications even when the diagnosis is done in asymptomatic patients. This is the report of two infants with who debuted with murmur and signs of heart failure. ARCAPA and Pulmonary Aortic Window were diagnosed and they were surgically corrected through intrapulmonary tunneling with a favorable evolution.

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