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Anomalous coronary artery

Discussion in 'Cardiology' started by Valery1957, Feb 13, 2019.

  1. Valery1957

    Valery1957 Famous Member

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    Published in Cardiology
    Journal Scan / Research · February 12, 2019

    Anomalous Coronary Artery Origin and Sudden Cardiac Death
    JACC: Clinical Electrophysiology

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    • The data from victims of sudden cardiac death (SCD) with anomalous origin of a coronary artery (AOCA) were retrospectively reviewed at a specialist cardiac pathology center. AOCA was detected in 30 of the 5100 cases of SCD. Cardiac symptoms (most commonly syncope) were reported by 11 individuals. The two most common variations of AOCA were an anomalous left coronary artery arising from the right sinus of Valsalva (ALCA) with an interarterial course (n = 11) and an anomalous right coronary artery arising from the left sinus of Valsalva (ARCA) with an interarterial course (n = 11). ALCA arising from the pulmonary artery was present in 7 cases, and the remaining had a left coronary artery which arose from the noncoronary cusp. SCD occurred during exercise or emotional stress in half the patients. Among the patients with ALCA, death occurred during exercise in 73% of cases vs 57% of those with ALCA arising from the pulmonary artery and 18% of those with ARCA.
    • AOCA is uncommon among victims of SCD, and the most commonly seen post-mortem variants are ALCA and ARCA with an interarterial course. ALCA is associated with death during physical exertion.



    Abstract
    This abstract is available on the publisher's site.

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    OBJECTIVES
    This study sought to describe the clinical and pathological features of anomalous origin of a coronary artery (AOCA) in sudden cardiac death (SCD) victims.

    BACKGROUND
    AOCA from the inappropriate sinus of Valsalva or from the pulmonary artery is increasingly diagnosed with current imaging techniques. AOCA is a possible cause of SCD.

    METHODS
    We reviewed a database of 5,100 consecutive cases of SCD referred to our specialist cardiac pathology center between January 1994 and March 2017 and identified a subgroup of 30 cases (0.6%) with AOCA. All cases underwent detailed post-mortem evaluation including histological analysis by an expert cardiac pathologist. Clinical information was obtained from referring coroners.

    RESULTS
    The mean age was 28 ± 16 years and 23 individuals were male (77%). In 8 cases (27%), SCD occurred before 18 years of age. Cardiac symptoms were present in 11 individuals (37%), and syncope was the most common (n = 6, 20%). Anomalous left coronary artery arising from the right sinus of Valsalva (ALCA) with interarterial course (n = 11) and anomalous right coronary artery arising from the left sinus of Valsalva (ARCA) with interarterial course (n = 11) were the most common found. ALCA arising from pulmonary artery was present in 7 cases, whereas in 1 case, the left coronary artery arose from the noncoronary cusp. Left ventricular fibrosis was reported in 11 cases (37%) and was mainly subendocardial. There was evidence of acute infarction in 2 cases. Death occurred during exercise or emotional stress in 15 (50%) cases. The AOCA variant where death occurred more frequently during physical activity was ALCA (8 of 11, 73%), followed by ALCA arising from pulmonary artery (4 of 7, 57%) and ARCA (2 of 11, 18%).

    CONCLUSIONS
    AOCA is a rare cause of SCD. ALCA and ARCA with interarterial course are the most common anatomical variants recognized at the post-mortem of SCD victims. ALCA is more commonly associated with death during exercise. Cardiac arrhythmia causing sudden death seems most likely in the cases without overt myocardial damage.
     

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