title: Stress-rest myocardial perfusion SPECT for functional assessment of coronary arteries with anomalous origin or course.
abstract: Anomalous coronary arteries (ACAs) may be clinically silent and totally benign or associated with catastrophic and fatal presentations. It has been postulated that the proximal course of an ACA is a decisive factor in risk stratification and surgical approach. Particularly, a course between the aorta and pulmonary trunk carries a high risk of major adverse events. We sought to evaluate the anatomic course of documented ACAs by transesophageal echocardiography (TEE) and to study their functional importance using stress-rest (99m)Tc-sestamibi ((99m)Tc-MIBI) myocardial perfusion SPECT.
  
  
  METHODS
  From a cohort of patients undergoing coronary angiography in our department between January 1997 and April 2003, we selected 14 with ACAs but without CAD (9 men and 5 women; mean age, 50.7 +/- 14.6 y). All patients underwent TEE and stress-rest (99m)Tc-MIBI myocardial perfusion SPECT.
  
  
  RESULTS
  TEE correctly identified the origin of all ACAs and revealed an anomalous course between the great vessels in 5 patients. At exercise myocardial perfusion SPECT, 4 of 14 patients demonstrated a reversible myocardial perfusion defect. All these patients had an anomalous course between the aorta and pulmonary artery.
  
  
  CONCLUSIONS
  In this study, 4 of 5 (80%) anomalous courses between the aorta and pulmonary artery were associated with the finding of a reversible perfusion defect on stress-rest SPECT. An integrated evaluation of anatomic course and hemodynamic importance could be useful in the management of ACA.
authors.affiliation: Department of Cardiology, Azienda Policlinico, Bari, Italy. leodeluca@virgilio.it
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.forename: Francesco
authors.initials: F
authors.lastname: Bovenzi
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubini
authors.forename: Artor
authors.initials: A
authors.lastname: Niccoli-Asabella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rubini
authors.forename: Italo
authors.initials: I
authors.lastname: De Luca
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi