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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Anomalous aortic origin of a coronary artery: toward a standardized approach

Carlos M Mery1, Silvana M Lawrence2, Rajesh Krishnamurthy3

  • 1Coronary Anomalies Program, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.

Seminars in Thoracic and Cardiovascular Surgery
|December 3, 2014
PubMed

Insights

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect. This review clarifies current knowledge gaps and proposes a standardized framework for evaluating and managing patients with this condition.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Cardiac Surgery

Background:

  • Anomalous aortic origin of a coronary artery (AAOCA) is a congenital abnormality where coronary arteries arise from the aorta abnormally.
  • AAOCA is the second most frequent cause of sudden cardiac death in young athletes.
  • Significant unknowns exist regarding AAOCA prevalence, pathophysiology, risk stratification, and optimal management.

Purpose of the Study:

  • To review the current understanding of anomalous aortic origin of a coronary artery (AAOCA).
  • To identify knowledge gaps in the pathophysiology, risk, evaluation, and treatment of AAOCA.
  • To introduce a framework for standardizing the evaluation and management of AAOCA patients.

Main Methods:

  • Literature review of existing studies on AAOCA.
  • Analysis of current knowledge and identification of research gaps.
  • Description of a multidisciplinary program for coronary anomalies.

Main Results:

  • The exact prevalence and risk of sudden cardiac death for various AAOCA types remain unclear.
  • Pathophysiological mechanisms leading to sudden cardiac death in AAOCA are not fully elucidated.
  • A framework for a multidisciplinary approach to standardize AAOCA evaluation and management has been developed.

Conclusions:

  • Further research is needed to address the unknowns surrounding AAOCA.
  • A standardized, multidisciplinary approach is crucial for optimal patient care.
  • Establishing dedicated programs can improve the evaluation and management of AAOCA.

Keywords:
anomalous aortic origin of a coronary arterycoronary anomaliessudden cardiac death

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