Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence
Coronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Vals...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2020.591326/full |
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| author | Marius Reto Bigler Afreed Ashraf Christian Seiler Fabien Praz Yasushi Ueki Stephan Windecker Alexander Kadner Lorenz Räber Christoph Gräni |
| author_facet | Marius Reto Bigler Afreed Ashraf Christian Seiler Fabien Praz Yasushi Ueki Stephan Windecker Alexander Kadner Lorenz Räber Christoph Gräni |
| author_sort | Marius Reto Bigler |
| collection | DOAJ |
| description | Coronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). The interarterial variants (with the anomalous vessel situated between the great arteries) are historically called “malignant,” based on an anticipated higher risk for myocardial ischemia and sudden cardiac death (SCD), especially affecting young patients during strenuous physical activity. However, the interarterial course itself may not be the predominant cause of ischemia, but rather represents a surrogate for other ischemia-associated anatomical high-risk features. As the exact pathophysiology of ACAOS is not well-understood, there is a lack of evidence-based guidelines addressing optimal diagnostic work-up, downstream testing, sports counseling, and therapeutic options in patients with ACAOS. Therefore, treating physicians are often left with uncertainty regarding the clinical management of affected patients. This review focuses on the pathophysiologic consequences of ACAOS on myocardial ischemia and discusses the concept of the interplay between fixed and dynamic coronary stenosis. Further, we discuss the advantages and limitations of the different diagnostic modalities and give an outlook by highlighting the gaps of knowledge in the assessment of such anomalies. |
| first_indexed | 2024-12-17T23:31:50Z |
| format | Article |
| id | doaj.art-1c6d2a226344415a90cb10f5a3e30849 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-17T23:31:50Z |
| publishDate | 2021-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1c6d2a226344415a90cb10f5a3e308492022-12-21T21:28:38ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-01-01710.3389/fcvm.2020.591326591326Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the EvidenceMarius Reto Bigler0Afreed Ashraf1Christian Seiler2Fabien Praz3Yasushi Ueki4Stephan Windecker5Alexander Kadner6Lorenz Räber7Christoph Gräni8Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiovascular Surgery, Centre for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandCoronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). The interarterial variants (with the anomalous vessel situated between the great arteries) are historically called “malignant,” based on an anticipated higher risk for myocardial ischemia and sudden cardiac death (SCD), especially affecting young patients during strenuous physical activity. However, the interarterial course itself may not be the predominant cause of ischemia, but rather represents a surrogate for other ischemia-associated anatomical high-risk features. As the exact pathophysiology of ACAOS is not well-understood, there is a lack of evidence-based guidelines addressing optimal diagnostic work-up, downstream testing, sports counseling, and therapeutic options in patients with ACAOS. Therefore, treating physicians are often left with uncertainty regarding the clinical management of affected patients. This review focuses on the pathophysiologic consequences of ACAOS on myocardial ischemia and discusses the concept of the interplay between fixed and dynamic coronary stenosis. Further, we discuss the advantages and limitations of the different diagnostic modalities and give an outlook by highlighting the gaps of knowledge in the assessment of such anomalies.https://www.frontiersin.org/articles/10.3389/fcvm.2020.591326/fullanomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS)multimodality imaginghemodynamic relevancefixed vs. dynamic stenosisanomalous aortic origin of the coronary artery (AAOCA)dobutamine-volume challenge |
| spellingShingle | Marius Reto Bigler Afreed Ashraf Christian Seiler Fabien Praz Yasushi Ueki Stephan Windecker Alexander Kadner Lorenz Räber Christoph Gräni Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence Frontiers in Cardiovascular Medicine anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) multimodality imaging hemodynamic relevance fixed vs. dynamic stenosis anomalous aortic origin of the coronary artery (AAOCA) dobutamine-volume challenge |
| title | Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence |
| title_full | Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence |
| title_fullStr | Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence |
| title_full_unstemmed | Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence |
| title_short | Hemodynamic Relevance of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva-In Search of the Evidence |
| title_sort | hemodynamic relevance of anomalous coronary arteries originating from the opposite sinus of valsalva in search of the evidence |
| topic | anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) multimodality imaging hemodynamic relevance fixed vs. dynamic stenosis anomalous aortic origin of the coronary artery (AAOCA) dobutamine-volume challenge |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2020.591326/full |
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