Current Management of Anomalous Aortic Origin of a Coronary Artery: A Pan-Canadian Survey

Background: Anomalous aortic origin of a coronary artery (AAOCA) is a significant cause of sudden cardiac death (SCD) in children and adolescents. The natural history of AAOCA and the pathophysiology of AAOCA-related SCD are poorly understood. Therefore, the evaluation and management of AAOCA remain controversial. This survey-based study aims to report the current AAOCA management tendencies in Canada. Methods: We built a 23-question survey on AAOCA. Questions pertained to patient presentation, investigations, morphology of the anomaly, management, and follow-up. We sent the survey to all the Canadian congenital cardiac surgeons, pediatric cardiologists, and adult congenital cardiologists. Data were anonymized and analysis was performed using descriptive statistics. Results: According to our survey participants (N = 47), patient age (94%) and amount of physical activity (60%) are the most influential factors when deciding whether to offer surgical correction. Aborted SCD, exercise-induced syncope, typical chest pain, and left jaw or arm pain are the most important clinical presentations indicating surgery. The most commonly used preoperative investigations are rest echocardiography (75%), electrocardiogram (68%), and exercise stress test (62%). Most respondents favor the unroofing procedure (78%) for surgical correction. For nonsurgical candidates, most physicians choose competitive exercise restriction (64%). Conclusion: We found a divergence between current practices and expert consensus guidelines regarding the treatment of asymptomatic left AAOCA with high-risk features. Our survey also revealed a lack of consensus among clinicians regarding the management of asymptomatic patients, very young patients, and those with right-sided AAOCA. Evidence-based criteria derived from sufficiently powered studies remain to be established to standardize AAOCA treatment.

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Hemodynamic Characteristics of Patients with Coronary Artery Disease Presenting False-Negative Exercise Stress Test

Angiology ◽

10.1177/000331979204300609 ◽

1992 ◽

Vol 43 (6) ◽

pp. 506-511 ◽

Cited By ~ 1

Author(s):

Michihito Sekiya ◽

Makoto Suzuki ◽

Yasushi Fujiwara ◽

Takumi Sumimoto ◽

Mareomi Hamada ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Test ◽

False Negative ◽

Exercise Stress Test ◽

Exercise Stress ◽

Hemodynamic Characteristics ◽

Artery Disease

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Recent advances in the role of the adenosinergic system in coronary artery disease

Cardiovascular Research ◽

10.1093/cvr/cvaa275 ◽

2020 ◽

Cited By ~ 1

Author(s):

Franck Paganelli ◽

Marine Gaudry ◽

Jean Ruf ◽

Régis Guieu

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Test ◽

Exercise Stress Test ◽

Tissue Hypoxia ◽

Exercise Stress ◽

Fractional Flow ◽

Coronary Syndrome ◽

Flow Reserve ◽

Artery Disease

Abstract Adenosine is an endogenous nucleoside that plays a major role in the physiology and physiopathology of the coronary artery system, mainly by activating its A2A receptors (A2AR). Adenosine is released by myocardial, endothelial, and immune cells during hypoxia, ischaemia, or inflammation, each condition being present in coronary artery disease (CAD). While activation of A2AR improves coronary blood circulation and leads to anti-inflammatory effects, down-regulation of A2AR has many deleterious effects during CAD. A decrease in the level and/or activity of A2AR leads to: (i) lack of vasodilation, which decreases blood flow, leading to a decrease in myocardial oxygenation and tissue hypoxia; (ii) an increase in the immune response, favouring inflammation; and (iii) platelet aggregation, which therefore participates, in part, in the formation of a fibrin-platelet thrombus after the rupture or erosion of the plaque, leading to the occurrence of acute coronary syndrome. Inflammation contributes to the development of atherosclerosis, leading to myocardial ischaemia, which in turn leads to tissue hypoxia. Therefore, a vicious circle is created that maintains and aggravates CAD. In some cases, studying the adenosinergic profile can help assess the severity of CAD. In fact, inducible ischaemia in CAD patients, as assessed by exercise stress test or fractional flow reserve, is associated with the presence of a reserve of A2AR called spare receptors. The purpose of this review is to present emerging experimental evidence supporting the existence of this adaptive adenosinergic response to ischaemia or inflammation in CAD. We believe that we have achieved a breakthrough in the understanding and modelling of spare A2AR, based upon a new concept allowing for a new and non-invasive CAD management.

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