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

作　　者：Alberto Cipriani Pietro Bernardo Dall’Aglio Laura Mazzotta Domenico Sirico George Sarris Mark Hazekamp Thierry Carrel Alessandro Frigiola Vladimir Sojak Mauro Lo Rito Jurgen Horer Regine Roussin Julie Cleuziou Bart Meyns Jose Fragata Helena Telles Anastasios C.Polimenakos Katrien Francois Altin Veshti Jukka Salminen Alvaro Gonzalez Rocafort Matej Nosal Eleftherios Protopapas Roberto Tumbarello Patrizio Sarto Cinzia Pegoraro Raffaella Motta Giovanni Di Salvo Domenico Corrado Vladimiro LVida Massimo 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》2022年第4期375-385,共11页先天性心脏病（英文）

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 

分 类 号：R541[医药卫生—心血管疾病]