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Publications

Journal Article Ahead of print

PubMed: 42876388 DOI: 10.1002/ccd.70891

Impaired Flow and Physiology in Coronaries With Anomalous Origin From the Opposite Sinus of Valsalva.

Catheter Cardiovasc Interv

Authors: Mauro Lo Rito, Mattia Squillace, Mauro Luca Agnifili, Antonio Rosato, Serena Anglese, Adele Chiavetta, Camilla Muritti, Miriam Deamici, Jessica Negri, Andrea Attanasio, Gianluigi Guida, Giandomenico Disabato, Francesco Secchi, Michele Conti, Alessandro Frigiola, Massimo Chessa, Alessandro Giamberti, Francesco Bedogni

Affiliations

  • Department of Pediatric and Adult Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Interventional Cardiology, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
  • 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Cardiology University Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Multimodality Cardiac Imaging Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
  • Cardiovascular Imaging Unit, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
  • Department of Civil Engineering and Architecture (DICAr), University of Pavia, Pavia, Italy.
  • Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.

Abstract

BACKGROUND

Anomalous Aortic Origin of a Coronary Artery (AAOCA) high-risk anatomical features (intramural segment, acute take-off angle, slit-like ostium) cause coronary stenosis leading to myocardial infarction. How these features alter coronary physiology remains unclear.

AIMS

We aimed to evaluate their impact on coronary blood supply using continuous thermodilution.

METHODS

We prospectively enrolled 51 AAOCA patients undergoing continuous thermodilution. Subjects were classified into an ischemic risk (IR) group (intramural segment, acute angle, oval or slit ostium) or non-ischemic risk (no-IR) group. Non-anomalous coronary arteries served as controls. We measured absolute coronary blood flow (CBF) and microvascular resistance.

RESULTS

Subjects (median age 48.4 years) presented mostly with angina, syncope, and arrhythmia. Final analysis included 48 AAOCA cases (31 IR, 17 no-IR) and 45 controls. The IR group had a median IM length of 9 mm, take-off angle of 31.9°, and a slit-like or oval ostium. The no-IR group had a median angle of 51.5° and an oval or round ostium. At rest, absolute CBF and microvascular resistance showed no significant differences among groups. However, during hyperemia, the IR group had significantly reduced CBF compared to controls (179 vs. 290 mL/min, p = 0.015). The IR group demonstrated higher microvascular resistance at rest (1473 vs. 1150, p = 0.024) and during hyperemia (433 vs. 305, p = 0.012), indicating persistently increased coronary vascular tone.

CONCLUSIONS

High-risk anatomical features of AAOCA are associated with altered coronary physiology. An intramural segment, acute take-off angle, and slit-like or oval ostium are linked to reduced hyperemic coronary blood flow due to increased microvascular resistance.

MeSH

Physiology, Hyperemia, Blood, Coronary Artery Disease, Arteries, Sinus Of Valsalva, Blood Circulation, Prognosis