Features associated with myocardial ischemia in anomalous aortic origin of a coronary artery: A Congenital Heart Surgeons' Society study

Anusha Jegatheeswaran, Paul J. Devlin, Brian W. McCrindle, William G. Williams, Marshall L Jacobs, Eugene H. Blackstone, William M. DeCampli, Christopher A. Caldarone, J. William Gaynor, James K. Kirklin, Richard O. Lorber, Carlos M. Mery, James D. St. Louis, Silvana Molossi, Julie A. Brothers

Research output: Contribution to journalArticle

Abstract

Objectives: We sought to determine anatomic features associated with evidence of myocardial ischemia and sudden cardiac events (arrest or death) for patients with anomalous aortic origin of a coronary artery. Methods: We enrolled 560 patients, less than or equal to 30 years, at diagnosis from 40 institutions. Ischemia was defined as the presence of exertional syncope, a sudden cardiac event (arrest/death), or abnormal investigation results. Data on detailed anatomic features were abstracted from echocardiography, computed tomography, magnetic resonance imaging, operative, and/or surgeon-completed reports. Results: There were 236 patients with negative ischemia test results, and 49 with evidence of ischemia (including 18 who presented with a sudden cardiac event); 275 asymptomatic patients who had not undergone provocative ischemia testing were excluded from primary analyses. Patients with ischemia (vs without), were more likely to have left anomalous coronary arteries (28/49 vs 46/236; P < .0001). Of patients with ischemia (vs without), those with anomalous left coronary arteries were more likely to have an intramural coronary artery course, or a high or slit-like coronary artery orifice. Of patients with ischemia (vs without), those with anomalous right coronary arteries were more likely to have a longer intramural course. Among patients with ischemia, the occurrence of sudden cardiac events was not shown to have any associated anatomic features. Conclusions: Anatomic features including coronary artery involved, intramural course and length, and orifice anomalies were associated with evidence of myocardial ischemia for patients with anomalous aortic origin of a coronary artery. These features might importantly inform risk stratification and decisions regarding surgical management.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StatePublished - Jan 1 2019

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Myocardial Ischemia
Coronary Vessels
Ischemia
Sudden Cardiac Death
Surgeons
Syncope
Echocardiography
Tomography
Magnetic Resonance Imaging

Keywords

  • anomalous aortic origin of a coronary artery
  • congenital heart disease
  • database
  • epidemiology
  • ischemia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Features associated with myocardial ischemia in anomalous aortic origin of a coronary artery : A Congenital Heart Surgeons' Society study. / Jegatheeswaran, Anusha; Devlin, Paul J.; McCrindle, Brian W.; Williams, William G.; Jacobs, Marshall L; Blackstone, Eugene H.; DeCampli, William M.; Caldarone, Christopher A.; Gaynor, J. William; Kirklin, James K.; Lorber, Richard O.; Mery, Carlos M.; St. Louis, James D.; Molossi, Silvana; Brothers, Julie A.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Jegatheeswaran, A, Devlin, PJ, McCrindle, BW, Williams, WG, Jacobs, ML, Blackstone, EH, DeCampli, WM, Caldarone, CA, Gaynor, JW, Kirklin, JK, Lorber, RO, Mery, CM, St. Louis, JD, Molossi, S & Brothers, JA 2019, 'Features associated with myocardial ischemia in anomalous aortic origin of a coronary artery: A Congenital Heart Surgeons' Society study', Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2019.02.122
Jegatheeswaran, Anusha ; Devlin, Paul J. ; McCrindle, Brian W. ; Williams, William G. ; Jacobs, Marshall L ; Blackstone, Eugene H. ; DeCampli, William M. ; Caldarone, Christopher A. ; Gaynor, J. William ; Kirklin, James K. ; Lorber, Richard O. ; Mery, Carlos M. ; St. Louis, James D. ; Molossi, Silvana ; Brothers, Julie A. / Features associated with myocardial ischemia in anomalous aortic origin of a coronary artery : A Congenital Heart Surgeons' Society study. In: Journal of Thoracic and Cardiovascular Surgery. 2019.
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abstract = "Objectives: We sought to determine anatomic features associated with evidence of myocardial ischemia and sudden cardiac events (arrest or death) for patients with anomalous aortic origin of a coronary artery. Methods: We enrolled 560 patients, less than or equal to 30 years, at diagnosis from 40 institutions. Ischemia was defined as the presence of exertional syncope, a sudden cardiac event (arrest/death), or abnormal investigation results. Data on detailed anatomic features were abstracted from echocardiography, computed tomography, magnetic resonance imaging, operative, and/or surgeon-completed reports. Results: There were 236 patients with negative ischemia test results, and 49 with evidence of ischemia (including 18 who presented with a sudden cardiac event); 275 asymptomatic patients who had not undergone provocative ischemia testing were excluded from primary analyses. Patients with ischemia (vs without), were more likely to have left anomalous coronary arteries (28/49 vs 46/236; P < .0001). Of patients with ischemia (vs without), those with anomalous left coronary arteries were more likely to have an intramural coronary artery course, or a high or slit-like coronary artery orifice. Of patients with ischemia (vs without), those with anomalous right coronary arteries were more likely to have a longer intramural course. Among patients with ischemia, the occurrence of sudden cardiac events was not shown to have any associated anatomic features. Conclusions: Anatomic features including coronary artery involved, intramural course and length, and orifice anomalies were associated with evidence of myocardial ischemia for patients with anomalous aortic origin of a coronary artery. These features might importantly inform risk stratification and decisions regarding surgical management.",
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T2 - A Congenital Heart Surgeons' Society study

AU - Jegatheeswaran, Anusha

AU - Devlin, Paul J.

AU - McCrindle, Brian W.

AU - Williams, William G.

AU - Jacobs, Marshall L

AU - Blackstone, Eugene H.

AU - DeCampli, William M.

AU - Caldarone, Christopher A.

AU - Gaynor, J. William

AU - Kirklin, James K.

AU - Lorber, Richard O.

AU - Mery, Carlos M.

AU - St. Louis, James D.

AU - Molossi, Silvana

AU - Brothers, Julie A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: We sought to determine anatomic features associated with evidence of myocardial ischemia and sudden cardiac events (arrest or death) for patients with anomalous aortic origin of a coronary artery. Methods: We enrolled 560 patients, less than or equal to 30 years, at diagnosis from 40 institutions. Ischemia was defined as the presence of exertional syncope, a sudden cardiac event (arrest/death), or abnormal investigation results. Data on detailed anatomic features were abstracted from echocardiography, computed tomography, magnetic resonance imaging, operative, and/or surgeon-completed reports. Results: There were 236 patients with negative ischemia test results, and 49 with evidence of ischemia (including 18 who presented with a sudden cardiac event); 275 asymptomatic patients who had not undergone provocative ischemia testing were excluded from primary analyses. Patients with ischemia (vs without), were more likely to have left anomalous coronary arteries (28/49 vs 46/236; P < .0001). Of patients with ischemia (vs without), those with anomalous left coronary arteries were more likely to have an intramural coronary artery course, or a high or slit-like coronary artery orifice. Of patients with ischemia (vs without), those with anomalous right coronary arteries were more likely to have a longer intramural course. Among patients with ischemia, the occurrence of sudden cardiac events was not shown to have any associated anatomic features. Conclusions: Anatomic features including coronary artery involved, intramural course and length, and orifice anomalies were associated with evidence of myocardial ischemia for patients with anomalous aortic origin of a coronary artery. These features might importantly inform risk stratification and decisions regarding surgical management.

AB - Objectives: We sought to determine anatomic features associated with evidence of myocardial ischemia and sudden cardiac events (arrest or death) for patients with anomalous aortic origin of a coronary artery. Methods: We enrolled 560 patients, less than or equal to 30 years, at diagnosis from 40 institutions. Ischemia was defined as the presence of exertional syncope, a sudden cardiac event (arrest/death), or abnormal investigation results. Data on detailed anatomic features were abstracted from echocardiography, computed tomography, magnetic resonance imaging, operative, and/or surgeon-completed reports. Results: There were 236 patients with negative ischemia test results, and 49 with evidence of ischemia (including 18 who presented with a sudden cardiac event); 275 asymptomatic patients who had not undergone provocative ischemia testing were excluded from primary analyses. Patients with ischemia (vs without), were more likely to have left anomalous coronary arteries (28/49 vs 46/236; P < .0001). Of patients with ischemia (vs without), those with anomalous left coronary arteries were more likely to have an intramural coronary artery course, or a high or slit-like coronary artery orifice. Of patients with ischemia (vs without), those with anomalous right coronary arteries were more likely to have a longer intramural course. Among patients with ischemia, the occurrence of sudden cardiac events was not shown to have any associated anatomic features. Conclusions: Anatomic features including coronary artery involved, intramural course and length, and orifice anomalies were associated with evidence of myocardial ischemia for patients with anomalous aortic origin of a coronary artery. These features might importantly inform risk stratification and decisions regarding surgical management.

KW - anomalous aortic origin of a coronary artery

KW - congenital heart disease

KW - database

KW - epidemiology

KW - ischemia

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