Pathophysiology and Treatment of Intraseptal-Course Left Coronary Anomaly: Surgery for All?

Area of Science:

• Cardiology
• Congenital Heart Disease
• Coronary Artery Anomalies

Background:

• Intraseptal-course ectopic coronary anomalies lack comprehensive characterization regarding anatomy, function, prognosis, and treatment.
• A recent theory posits that Left Anomalous Coronary Artery originating from the Opposite Sinus with anomalous Intra-Septal course (L-ACAOS-IS) frequently causes significant stenosis, necessitating surgery, even in children.

Purpose of the Study:

• To provide a comprehensive review of L-ACAOS-IS, presenting data that contrasts with recent claims of high stenosis and surgical necessity.
• To analyze the anatomical and functional aspects of L-ACAOS-IS, correlating them with prognosis and treatment indications.

Main Methods:

• Review of long-term clinical data and observations of numerous L-ACAOS-IS patients by adult cardiologists.
• Analysis of the general principles of coronary artery dysfunction in congenital anomalies.
• Evaluation of anatomical and functional details specific to L-ACAOS-IS.

Main Results:

• Contrary to recent theories, L-ACAOS-IS patients, including children, have generally exhibited a benign clinical prognosis.
• No observed catastrophes or widespread significant stenoses were noted in long-term follow-up of L-ACAOS-IS patients.
• Coronary spasm, potentially exacerbated by pressure wire artifacts, may contribute to ischemic manifestations in anomalous coronary arteries.

Conclusions:

• L-ACAOS-IS is generally associated with a benign clinical course, challenging the notion of routine surgical intervention.
• Significant luminal coronary stenosis is the primary determinant of clinical repercussions in coronary artery anomalies.
• Anomalous coronary arteries, including L-ACAOS-IS, may be prone to coronary spasm, and ischemic symptoms could be influenced by procedural artifacts.