TY  - EJOU
AU  - Cipriani, Alberto 
AU  - Dall’Aglio, Pietro Bernardo 
AU  - Mazzotta, Laura 
AU  - Sirico, Domenico 
AU  - Sarris, George 
AU  - Hazekamp, Mark 
AU  - Carrel, Thierry 
AU  - Frigiola, Alessandro 
AU  - Sojak, Vladimir 
AU  - Rito, Mauro Lo 
AU  - Horer, Jurgen 
AU  - Roussin, Regine 
AU  - Cleuziou, Julie 
AU  - Meyns, Bart 
AU  - Fragata, Jose 
AU  - Telles, Helena 
AU  - Polimenakos, Anastasios C. 
AU  - Francois, Katrien 
AU  - Veshti, Altin 
AU  - Salminen, Jukka 
AU  - Rocafort, Alvaro Gonzalez 
AU  - Nosal, Matej 
AU  - Protopapas, Eleftherios 
AU  - Tumbarello, Roberto 
AU  - Sarto, Patrizio 
AU  - Pegoraro, Cinzia 
AU  - Motta, Raffaella 
AU  - Salvo, Giovanni Di 
AU  - Corrado, Domenico 
AU  - Vida, Vladimiro L. 
AU  - Padalino, Massimo A. 

TI  - Diagnostic Yield of Non-Invasive Testing in Patients with Anomalous Aortic Origin of Coronary Arteries: A Multicentric Experience
T2  - Structural and Congenital Heart Disease

PY  - 2022
VL  - 17
IS  - 4
SN  - 3071-1738

AB  - <b>Background:</b> 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. <b>Methods</b>: 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. <b>Results:</b> 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% <i>vs.</i> 5%, <i>P</i> = 0.002), in particular when associated with inter-arterial course (22% <i>vs.</i> 5%, <i>P</i> < 0.001). <b>Conclusion:</b> 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.
KW  - Anomalous coronary arteries; congenital; echocardiography; coronary computed tomography angiography

DO  - 10.32604/chd.2022.019385