Invited Commentary: Notwithstanding the Significance of Anatomy in Anomalous Aortic Origin of a Coronary Artery, Physiology Is Important, Too

Area of Science:

• Cardiology
• Medical Devices
• Diagnostic Tools

Background:

• Management strategies for anomalous aortic origin of a coronary artery (AAOCA) rely on limited evidence from anatomical assessments, symptoms, and stress tests.
• Current physiological tests like stress tests for ischemia or ventricular dysfunction lack adequate reliability for guiding AAOCA management.
• There is a need for more robust physiological metrics to develop reliable management strategies for AAOCA.

Purpose of the Study:

• To explore the potential utility of Fractional Flow Reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) in assessing anomalous aortic origin of a coronary artery (AAOCA).
• To review existing studies on FFR and iFR in acquired coronary artery disease (CAD) and their preliminary application in AAOCA.
• To highlight the unique challenges and future research directions for employing FFR and iFR in AAOCA management.

Main Methods:

• Review of existing literature on FFR and iFR in acquired coronary artery disease (CAD).
• Examination of small-scale studies investigating FFR/iFR application in anomalous aortic origin of a coronary artery (AAOCA).
• Commentary on the specific anatomical and physiological considerations for FFR/iFR use in AAOCA.

Main Results:

• FFR and iFR are established physiological measurements for assessing acquired coronary artery disease (CAD).
• Preliminary studies suggest potential, but limited, use of FFR/iFR in anomalous aortic origin of a coronary artery (AAOCA).
• Unique features of AAOCA necessitate further research for accurate FFR/iFR conduct and interpretation.

Conclusions:

• Current management of anomalous aortic origin of a coronary artery (AAOCA) requires improved evidence-based strategies.
• FFR and iFR present a potential avenue for more reliable physiological assessment in AAOCA.
• Extensive research and multi-institutional collaboration are crucial to validate FFR/iFR effectiveness and guide AAOCA management.