Diagnostic Yield of Non-Invasive Testing in Patients with Anomalous Aortic Origin of Coronary Arteries:A Multicentric Experience

查看全文 作　　者：Alberto [1]Cipriani;Pietro Bernardo Dall’[1]Aglio;Laura [1]Mazzotta;Domenico [2]Sirico;George [3]Sarris;Mark [4]Hazekamp;Thierry [5]Carrel;Alessandro [6]Frigiola;Vladimir [4]Sojak;Mauro Lo [6]Rito;Jurgen [7]Horer;Regine [7]Roussin;Julie [8]Cleuziou;Bart [9]Meyns;Jose [10]Fragata;Helena [10]Telles;Anastasios [11]C.Polimenakos;Katrien [12]Francois;Altin [13]Veshti;Jukka [14]Salminen;Alvaro Gonzalez [15]Rocafort;Matej [16]Nosal;Eleftherios [3]Protopapas;Roberto [17]Tumbarello;Patrizio [18]Sarto;Cinzia [18]Pegoraro;Raffaella [19]Motta;Giovanni Di [2]Salvo;Domenico [1]Corrado;Vladimiro [1]LVida;Massimo [1,2]A.Padalino 机构地区：[1]Department of Cardio-Thoracic,Vascular Sciences and Public Health,University of Padova,Padova,Italy;[2]Department of Woman and Child’s Health,Pediatric Cardiology,University of Padova,Padova,Italy;[3]Athens Heart Surgery Institute and Iaso Children’s Hospital,Athens,Greece;[4]Department for Cardiovascular Surgery,University Medical Center,Leiden,The Netherlands;[5]Department for Cardiovascular Surgery,University Hospital Bern,Bern,Switzerland;[6]Department of Congenital Cardiac Surgery,IRCCS Policlinico San Donato,San Donato Milanese,Italy;[7]Department of Pediatric Cardiology and Congenital Heart Disease,Hôpital Marie Lannelongue,UniversitéParis-Sud,Le Plessis-Robinson,France;[8]Deutsch Herz Zentrum,Munich,Germany;[9]Katholieke Universiteit Leuven,Leuven,Belgium;[10]Cardiothoracic Surgery Hospital de Santa Marta Rua,Lisbon,Portugal;[11]Department of Pediatric Cardiothoracic Surgery,Children’s Hospital of Georgia,Georgia,USA;[12]Department of Cardiac Surgery,University Hospital Ghent,Ghent,Belgium;[13]Division of Cardiac Surgery,University Hospital Center of Tirana,Tirana,Albania;[14]Department of Pediatric Cardiac Surgery,Hospital for Children and Adolescents,University of Helsinki,Helsinki,Finland;[15]Congenital Cardiac Surgery Department,Hospital Universitario La Paz,Madrid,Spain;[16]Department of Pediatric Cardiac Surgery,National Institute of Cardio-Vascular Diseases-Children’s Heart Center,Bratislava,Slovakia;[17]Division of Pediatric Cardiology,Ospedale Brotzu,Cagliari,Italy;[18]Division of Sport Medicine,Ospedale Ca’Foncello,Treviso,Italy;[19]Department of Medicine,Radiology Clinic,University of Padua Medical School,Padova,Italy 出　　处：《Congenital Heart Disease》索引2022年第17卷第4期,共11页 摘　　要：Background:Anomalous aortic origin of a coronary artery(AAOCA)is a congenital heart disease with a 0.3%−0.5%prevalence.Diagnosis is challenging due to nonspecific clinical presentation.Risk stratification and treatment are currently based on expert consensus and single-center case series.Methods:Demographical and clinical data of AAOCA patients from 17 tertiary-care centers were analyzed.Diagnostic imaging studies(Bidimensional echocardiography,coronary computed tomography angiography[CCTA]were collected.Clinical correlations with anomalous coronary course and origin were evaluated.Results:Data from 239 patients(42%males,mean age 15 y)affected by AAOCA were collected;154 had AAOCA involving the right coronary artery(AAORCA),62 the left(AAOLCA),23 other anomalies.211(88%)presented with an inter-arterial course.Basal electrocardiogram(ECG)was abnormal in 37(16%).AAOCA was detected by transthoracic echocardiography and CCTA in 53%and 92%of patients,respectively.Half of the patients reported cardiac symptoms(119/239;50%),mostly during exercise in 121/178(68%).An ischemic response was demonstrated in 37/106(35%)and 16/31(52%)of patients undergoing ECG stress test and stress-rest single positron emission cardiac tomography.Compared with AAORCA,patients with AAOLCA presented more frequently with syncope(18%vs.5%,P=0.002),in particular when associated with inter-arterial course(22%vs.5%,P<0.001).Conclusion:Diagnosis of AAOCA is a clinical challenge due to nonspecific clinical presentations and low sensitivity of first-line cardiac screening exams.Syncope seems to be strictly correlated to AAOLCA with inter-arterial course. 关 键 词：Anomalous coronary arteries CONGENITAL ECHOCARDIOGRAPHY coronary computed tomography angiography