Anomalous Aortic Origin of a Coronary Artery From the Inappropriate Sinus of Valsalva.
Anomalous aortic origin of a coronary artery (AAOCA) from the inappropriate sinus of Valsalva is increasingly recognized by cardiac imaging. Although most AAOCA subtypes are benign, autopsy studies report an associated risk of sudden death with interarterial anomalous left coronary artery (ALCA) and anomalous right coronary artery (ARCA). Despite efforts to identify high-risk ALCA and ARCA patients who may benefit from surgical repair, debate remains regarding their classification, prevalence, risk stratification, and management. We comprehensively reviewed 77 studies reporting the prevalence of AAOCA among >1 million patients, and 20 studies examining outcomes of interarterial ALCA/ARCA patients. Observational data suggests that interarterial ALCA is rare (weighted prevalence = 0.03%; 95% confidence interval [CI]: 0.01% to 0.04%) compared with interarterial ARCA (weighted prevalence = 0.23%; 95% CI: 0.17% to 0.31%). Recognizing the challenges in managing these patients, we review cardiac tests used to examine AAOCA and knowledge gaps in management.
Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Cardiology Service, Fort Belvoir Community Hospital, Ft. Belvoir, Virginia. Electronic address: mcheezum@gmail.com.
Michael K
MK
Cheezum
Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Richard R
RR
Liberthson
Lifespan Cardiovascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Brown University Alpert School of Medicine, Providence, Rhode Island.
Nishant R
NR
Shah
Department of Medicine, Cardiology Service, Walter Reed National Military Medical Center, Bethesda Maryland.
Todd C
TC
Villines
Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Patrick T
PT
O'Gara
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Michael J
MJ
Landzberg
Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Ron
R
Blankstein
D057791:Cardiac Imaging Techniques; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015995:Prevalence
anomalous coronary artery; interarterial; management; outcomes; prevalence; sudden cardiac death