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Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment.

Rigatelli G, Dell'Avvocata F, Van Tan N, Daggubati R, Nanijundappa A - J Geriatr Cardiol (2015)

Bottom Line: The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment.A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture.Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success.

View Article: PubMed Central - PubMed

Affiliation: Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.

ABSTRACT
Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.

No MeSH data available.


Related in: MedlinePlus

Challenging case of 81-year old patient with acute coronary syndrome and down-warded origin of the right coronary artery from the opposite sinus without intramural course (A); the ostium could not be cannulated correctly from the femoral approach with standard catheter, and it was cannulated through the radial artery approach with a Champ catheter (B); stenting with a drug eluting stent was accomplished from radial artery approach (C).
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jgc-12-01-066-g004: Challenging case of 81-year old patient with acute coronary syndrome and down-warded origin of the right coronary artery from the opposite sinus without intramural course (A); the ostium could not be cannulated correctly from the femoral approach with standard catheter, and it was cannulated through the radial artery approach with a Champ catheter (B); stenting with a drug eluting stent was accomplished from radial artery approach (C).

Mentions: (2): Ectopic origin of LCA from the right sinus of Valsalva is differently significant depending on its origin and relationship with the aorta and pulmonary artery: “septal” subtype is the most common finding, while “between” one is rare but often dangerous.[19] Ectopic origin of the RCA from the left sinus of Valsalva, due to its route between aorta and pulmonary arteries and its occlusion during the expansion of the aorta, is a less dangerous anomaly.[20] The pathophysiology of these anomalies is complex: the proximal portion of the anomalous vessel often exits the aorta with an acute angle, creating functional or actual ostial stenosis. The proximal portion can also course between the aorta and pulmonary artery and can be impinged during exertion by pressure and volume expansion of the pulmonary artery against the aorta, causing perfusion mismatch; finally and probably most frequently, the proximal portion may course through the wall of the aorta resulting in narrowing of the lumen. Intravascular ultrasound interrogation during induced stress may be needed to assess risk of stress induced myocardial ischemia due to dynamic compression of the intramural segment of the anomalous vessel (Figure 4).[21]


Congenital coronary artery anomalies silent until geriatric age: non-invasive assessment, angiography tips, and treatment.

Rigatelli G, Dell'Avvocata F, Van Tan N, Daggubati R, Nanijundappa A - J Geriatr Cardiol (2015)

Challenging case of 81-year old patient with acute coronary syndrome and down-warded origin of the right coronary artery from the opposite sinus without intramural course (A); the ostium could not be cannulated correctly from the femoral approach with standard catheter, and it was cannulated through the radial artery approach with a Champ catheter (B); stenting with a drug eluting stent was accomplished from radial artery approach (C).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4308460&req=5

jgc-12-01-066-g004: Challenging case of 81-year old patient with acute coronary syndrome and down-warded origin of the right coronary artery from the opposite sinus without intramural course (A); the ostium could not be cannulated correctly from the femoral approach with standard catheter, and it was cannulated through the radial artery approach with a Champ catheter (B); stenting with a drug eluting stent was accomplished from radial artery approach (C).
Mentions: (2): Ectopic origin of LCA from the right sinus of Valsalva is differently significant depending on its origin and relationship with the aorta and pulmonary artery: “septal” subtype is the most common finding, while “between” one is rare but often dangerous.[19] Ectopic origin of the RCA from the left sinus of Valsalva, due to its route between aorta and pulmonary arteries and its occlusion during the expansion of the aorta, is a less dangerous anomaly.[20] The pathophysiology of these anomalies is complex: the proximal portion of the anomalous vessel often exits the aorta with an acute angle, creating functional or actual ostial stenosis. The proximal portion can also course between the aorta and pulmonary artery and can be impinged during exertion by pressure and volume expansion of the pulmonary artery against the aorta, causing perfusion mismatch; finally and probably most frequently, the proximal portion may course through the wall of the aorta resulting in narrowing of the lumen. Intravascular ultrasound interrogation during induced stress may be needed to assess risk of stress induced myocardial ischemia due to dynamic compression of the intramural segment of the anomalous vessel (Figure 4).[21]

Bottom Line: The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment.A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture.Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success.

View Article: PubMed Central - PubMed

Affiliation: Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.

ABSTRACT
Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, functional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional significance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.

No MeSH data available.


Related in: MedlinePlus