Diagnosis and Management of Anomalous Coronary Arteries with a Malignant Course
Christoph Gräni1,2, Philipp A Kaufmann2, Stephan Windecker1
1Department of Cardiology, Bern University Hospital Bern, Switzerland.
Insights
Anomalous coronary artery from the opposite sinus (ACAOS) is rare but increasingly detected. Malignant ACAOS variants can cause sudden cardiac death in athletes, while older individuals may be less affected. Imaging guides patient management.
Area of Science:
- Cardiology
- Medical Imaging
- Anatomical Pathology
Background:
- Anomalous coronary artery from the opposite sinus (ACAOS) is a rare congenital heart condition.
- Increased use of cardiac imaging has led to a rise in ACAOS detection.
- ACAOS are classified into malignant (interarterial course) and benign variants.
Purpose of the Study:
- To review the clinical significance and diagnostic approaches for ACAOS.
- To highlight the association of malignant ACAOS with sudden cardiac death in young athletes.
- To discuss the role of non-invasive imaging in evaluating ACAOS.
Main Methods:
- Review of existing literature on ACAOS.
- Analysis of autopsy and imaging studies.
- Discussion of diagnostic criteria and management strategies.
Main Results:
- Malignant ACAOS variants are linked to sudden cardiac death, particularly in young athletes.
- Older individuals with ACAOS appear less susceptible to adverse cardiac events.
- Non-invasive anatomic and functional imaging aids in identifying high-risk ACAOS features and potential ischemia.
Conclusions:
- ACAOS management is guided by clinical imaging findings.
- Non-invasive imaging plays a crucial role in assessing ACAOS risk and guiding treatment.
- Understanding ACAOS variants is vital for appropriate patient care and risk stratification.
Abstract:
Although the prevalence of anomalous coronary artery from the opposite sinus (ACAOS) in the general population is low, more frequent use of invasive and non-invasive imaging to rule out coronary artery disease has seen an increase in absolute numbers of ACAOS. ACAOS are traditionally classified as malignant (with an interarterial course) and benign variants. Malignant variants have been recognised in autopsy studies to be an underlying cause of sudden cardiac death in young athletes. Conversely, it seems that older people with ACAOS are less predisposed to adverse cardiac events. Non-invasive anatomic imaging is complementary to invasive imaging and helps to further identify high-risk anatomic features. Using functional non-invasive perfusion imaging can assess potential ischaemia induced by dynamic compression of malignant ACAOS. Information gained from clinical imaging guides the management of these patients.
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