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

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

Scientific Reports ◽

10.1038/s41598-021-97917-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Francisco Albuquerque ◽

Pedro de Araújo Gonçalves ◽

Hugo Marques ◽

António Ferreira ◽

Pedro Freitas ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Right Coronary Artery ◽

Cardiac Death ◽

Anomalous Origin ◽

Cardiac Symptoms ◽

Asymptomatic Patients ◽

Increased Risk ◽

The Right

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 left anterior descending coronary artery from the right coronary artery with an interarterial and intramyocardial course: a long-term follow-up

The European Research Journal ◽

10.18621/eurj.2016.5000187785 ◽

2016 ◽

Vol 0 (0) ◽

Author(s):

Aydin Dursun ◽

Nurullah Dogan ◽

Hakan Ozkan

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Anomalous Origin ◽

Long Term Follow Up ◽

The Right

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A right coronary artery aneurysm 16 years after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivy356 ◽

2019 ◽

Vol 29 (1) ◽

pp. 157-158

Author(s):

Akira Furutachi ◽

Kojiro Furukawa ◽

Aiko Komatsu ◽

Eijiro Nogami

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Surgical Repair ◽

Artery Aneurysm ◽

Anomalous Origin ◽

Artery Graft ◽

Long Term Follow Up ◽

The Right

Abstract Anomalous origin of the right coronary artery (RCA) from the pulmonary artery is a very rare congenital heart disease, and several reports have described long-term events after surgery. We report the case of a 46-year-old woman who underwent reimplantation of the RCA for anomalous origin of the right coronary artery from the pulmonary artery 16 years ago. An RCA aneurysm gradually developed and dilated over time, and we resected the aneurysm and also grafted the right gastroepiploic artery graft to the distal RCA. Careful long-term follow-up is required to avoid overlooking such a rare but life-threatening complication after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery.

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Long-term outcomes after coronary artery bypass surgery in patients with diabetes

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa009 ◽

2020 ◽

Vol 30 (5) ◽

pp. 685-690

Author(s):

Tomas Andri Axelsson ◽

Jonas A Adalsteinsson ◽

Linda O Arnadottir ◽

Dadi Helgason ◽

Hera Johannesdottir ◽

...

Keyword(s):

Overall Survival ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Long Term Outcomes ◽

Cerebrovascular Events ◽

Increased Risk ◽

Patients With Diabetes

Abstract OBJECTIVES Our aim was to investigate the outcome of patients with diabetes undergoing coronary artery bypass grafting (CABG) surgery in a whole population with main focus on long-term mortality and complications. METHODS This was a nationwide retrospective analysis of all patients who underwent isolated primary CABG in Iceland between 2001 and 2016. Overall survival together with the composite end point of major adverse cardiac and cerebrovascular events was compared between patients with diabetes and patients without diabetes during a median follow-up of 8.5 years. Multivariable regression analyses were used to evaluate the impact of diabetes on both short- and long-term outcomes. RESULTS Of a total of 2060 patients, 356 (17%) patients had diabetes. Patients with diabetes had a higher body mass index (29.9 vs 27.9 kg/m2) and more often had hypertension (83% vs 62%) and chronic kidney disease (estimated glomerular filtration rate ≤60 ml/min/1.73 m2, 21% vs 14%). Patients with diabetes had an increased risk of operative mortality [odds ratio 2.52, 95% confidence interval (CI) 1.27–4.80] when adjusted for confounders. 5-Year overall survival (85% vs 91%, P < 0.001) and 5-year freedom from major adverse cardiac and cerebrovascular events were also inferior for patients with diabetes (77% vs 82%, P < 0.001). Cox regression analysis adjusting for potential confounders showed that the diagnosis of diabetes significantly predicted all-cause mortality [hazard ratio (HR) 1.87, 95% CI 1.53–2.29] and increased risk of major adverse cardiac and cerebrovascular events (HR 1.47, 95% CI 1.23–1.75). CONCLUSIONS Patients with diabetes have significantly lower survival after CABG, both within 30 days and during long-term follow-up.

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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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