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André CO, Hodzic A, Dolladille C, Maragnes P, Cousergue C, Ollitrault P, Sayegh J, Belli E, Labombarda F. Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus. Front Cardiovasc Med 2023; 10:1099544. [PMID: 37082453 PMCID: PMC10111027 DOI: 10.3389/fcvm.2023.1099544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
Objectives We sought to assess the resumption of sport, exercise performances, and quality of life (QoL) in adults and children after surgical repair of anomalous coronary arteries originating from the opposite sinus (ACAOS). Materials and methods Patients who underwent surgical repair for ACAOS between 2002 and 2022 were retrospectively identified. Information about sports activity and exercise performance based on metabolic equivalents of task (METs) calculated at the last exercise stress test, were collected. QoL was assessed using age-appropriate questionnaires (Paediatric QoL Inventory, cardiac module version 3.0 for patients <18 years; SF-36 QoL Inventory for adults). Patients' METS and patients' QoL-scores were compared to reference population using the Wilcoxon test. Results 45 patients were enrolled (males 71%, adults 49%, anomalous right coronary 84%). Median age at surgery was 15 years; median follow-up after surgery was 2.3 years [4 months-12 years]. All post-operative exercise stress tests were normal, METs and VO2 max patients' values did not differ from healthy children or adults (Exercise intensity: 12.5 ± 4.7 vs. 13.4 ± 2 METS, p = 0.3; VO2 max: 43.6 ± 16.6 vs. 46.9 ± 7 ml/kg/min, p = 0.37). For adults, QoL-scores were similar between ACAOS patients and controls. For children, there was no significant difference between the study patients' scores and those of the reference population, except for physical appearance proxy-report (p = 0.02). Conclusion In our study, the practice of sports, exercise stress testing and QoL were not adversely affected after ACAOS repair.
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Affiliation(s)
| | - Amir Hodzic
- Department of Cardiology, Normandie University, UNICAEN, CHU Caen-Normandie, Inserm Comete, GIP Cyceron, Caen, France
| | - Charles Dolladille
- Pharmacoepidemiology Unit, Department of Pharmacology, Normandie University, UNICAEN, CHU Caen-Normandie, Caen, France
| | | | - Cynthia Cousergue
- Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France
| | | | - Jimmy Sayegh
- Department of Pediatrics, CHU de Caen-Normandie, Caen, France
| | - Emré Belli
- Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France
| | - Fabien Labombarda
- Department of Cardiology, Normandie University, UNICAEN, CHU Caen-Normandie, UR 4650 PSIR, Caen, France
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Ponzoni M, Frigo AC, Padalino MA. Surgery for Anomalous Aortic Origin of a Coronary Artery (AAOCA) in Children and Adolescents: A Meta-Analysis. World J Pediatr Congenit Heart Surg 2022; 13:485-494. [PMID: 35757950 DOI: 10.1177/21501351221095424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We conducted a systematic review and meta-analysis of the literature to assess the outcomes of surgery for the anomalous aortic origin of a coronary artery in children and young adults (<30 years). Thirteen publications were selected, including a total of 384 patients. Unroofing of the intramural segment was adopted in 92% (95% CI: 81%-98%) of cases, with pooled early and late mortality of 0% (95% CI: 0%-0.3%) and 0.1% (95% CI: 0%-1%), respectively. Reoperation for aortic regurgitation was anecdotal. Surgical management of anomalous aortic origin of coronary arteries can be achieved with excellent results in pediatric patients, but concerns remain about the durability of surgery.
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Affiliation(s)
- Matteo Ponzoni
- Pediatric and Congenital Cardiac Surgery Unit, Padova, Veneto, Italy
| | - Anna C Frigo
- Unit of Biostatistics, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova Medical School, Italy
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3
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Gharibeh L, Rahmouni K, Hong SJ, Crean AM, Grau JB. Surgical Techniques for the Treatment of Anomalous Origin of Right Coronary Artery From the Left Sinus: A Comparative Review. J Am Heart Assoc 2021; 10:e022377. [PMID: 34726074 PMCID: PMC8751967 DOI: 10.1161/jaha.121.022377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The anomalous aortic origin of the right coronary artery (AAORCA) from the left sinus is a congenital anomaly affecting both the origin and course of the right coronary artery. AAORCA is nowadays easily and increasingly recognized by several cardiac imaging modalities. In most cases, patients remain asymptomatic; however, in some, and especially in young athletes, symptoms start to appear following exertion. A literature review was conducted on the surgical management of AAORCA by searching the Pubmed and Google Scholar databases. The inclusion criteria included manuscripts reporting surgical outcomes of AAORCA for ≥1 of the 3 techniques of interest (unroofing, reimplantation, and coronary artery bypass grafting) and manuscripts written in English and that were published between 2010 and 2020. The surgical management of AAORCA can be done through several techniques, most commonly the unroofing of the intramural segment of the AAORCA, the reimplantation of the native right coronary artery onto the right sinus of the aortic root, and coronary artery bypass grafting with either arterial or venous graft conduits with or without ligation of the proximal right coronary artery. Superiority of one surgical technique has not yet been formally proven because of the rare nature of this condition and the lack of any prospective randomized controlled trial or robust prospective observational studies.
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Affiliation(s)
- Lara Gharibeh
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada.,Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
| | - Kenza Rahmouni
- Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
| | - Seok Joon Hong
- Division of Cardiothoracic Surgery The Valley Hospital Ridgewood NJ
| | - Andrew M Crean
- Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Juan B Grau
- Division of Cardiac Surgery University of Ottawa Heart Institute Ottawa Ontario Canada.,Division of Cardiothoracic Surgery The Valley Hospital Ridgewood NJ
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4
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Kohli U, Nayak HM, Romme AG, Nguyen HH. Resting electrocardiographic differences in ventricular repolarization between children and young adults with congenital heart disease and those with a structurally normal heart are diminished by exercise. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1047-1053. [PMID: 33835488 DOI: 10.1111/pace.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/15/2021] [Accepted: 03/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Exercise-induced repolarization changes have not been systematically evaluated in children and young adults with congenital heart disease (CHD). We carried out this study to assess the QTc responses during exercise in children and young adults (≤ 21 years) with CHD with comparison to those with structurally normal hearts. METHODS Baseline QRS duration, calculated baseline QTc, QTc at 4 min of recovery and delta QTc was measured in 360 exercise stress tests which were performed in 360 subjects (137 stress tests in patients with CHD [CHD group] and 223 stress tests in patients with structurally normal hearts). The effects of presence of CHD and potential confounders on primary outcome measure, change in QTc (delta QTc), and secondary outcome measures (QTc at baseline and QTc at 4 min of recovery) were determined using multiple linear regression analyses. RESULTS The baseline QTc and the QTc at 4 min of recovery in the CHD group was longer than patients with structurally normal hearts (respective p values = .00 and .001). No significant difference was noted in delta QTc between the CHD and structurally normal heart groups. CONCLUSIONS While patients with CHD had a longer QRS duration and QTc interval at baseline than those with structurally normal hearts, these differences did not persist or augment with exercise.
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Affiliation(s)
- Utkarsh Kohli
- Department of Pediatrics, Comer Children's Hospital and The Pritzker School of Medicine of the University of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, West Virginia University Children's Hospital and West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Hemal M Nayak
- Center for Arrhythmia Care, Pritzker School of Medicine of the University of Chicago, Chicago, Illinois, USA
| | - Angela G Romme
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - Hoang H Nguyen
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA.,Department of Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
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5
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Agrawal H, Mery CM, Sami SA, Qureshi AM, Noel CV, Cutitta K, Masand P, Tejtel SKS, Wang Y, Molossi S. Decreased Quality of Life in Children With Anomalous Aortic Origin of a Coronary Artery. World J Pediatr Congenit Heart Surg 2021; 12:204-210. [PMID: 33684009 DOI: 10.1177/2150135120978766] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden death in the young. We sought to determine quality of life (QOL) in patients/families affected by AAOCA. METHODS Patients with AAOCA (8-18 years) were prospectively included from January 2016 to May 2017. Parent proxy and patient Pediatric Cardiac Quality of Life Inventory (PCQLI) were used to evaluate QOL and Pediatric Quality of Life Inventory (PedsQL) Family Impact Module to assess the impact of AAOCA on families, as primary outcomes. Secondary outcomes included peer relationship, anxiety, and depression assessed using patient-reported outcomes measurement information system. Patients deemed high-risk were offered surgery/exercise restriction. Generalized linear mixed regression models were used to determine significant predictors of outcomes. RESULTS Fifty-three patients, the majority (n = 31, 59%) unrepaired, and 49 caregivers were included. Using PCQLI, patient and parent proxy QOL scores were similar to published scores for children with long-QT syndrome. Patients' QOL score was associated with exertional symptoms, perceived chronic disease, and altered parent's concentration ability. Likewise, parent proxy QOL scores were associated with mother's living situation, exertional symptoms, parent missing work for ≥1 day, and disturbed parental functioning at work. Family impact scores were associated with lower maternal education, among other measures. Risk categories or surgical status did not impact patient, parent proxy reported, or family impact QOL. CONCLUSION Anomalous aortic origin of a coronary artery is associated with decreased QOL as perceived by patients and caregiver and is associated with numerous facets of family functioning. These findings are independent of risk categorization or surgical status.
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Affiliation(s)
- Hitesh Agrawal
- Pediatric and Congenital Cardiology Associates, 441903The University of Texas at Austin Dell Medical School, Austin, TX
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Sarah A Sami
- 3989Baylor College of Medicine, Office of Surgical Research, Houston, TX, USA
| | - Athar M Qureshi
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology, 3984Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Cory V Noel
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology, 3984Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Katherine Cutitta
- Department of Pediatrics, Section of Psychology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Prakash Masand
- Pediatric Radiology, 3984Texas Children's Hospital, Houston, TX, USA
| | - S Kristen Sexson Tejtel
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology, 3984Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Yunfei Wang
- The Lillie Frank Abercrombie Section of Pediatric Cardiology, 3984Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Silvana Molossi
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology, 3984Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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6
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Determinants of electrocardiographic abnormalities in patients with pectus excavatum. J Electrocardiol 2021; 65:91-95. [PMID: 33582499 DOI: 10.1016/j.jelectrocard.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Electrocardiographic abnormalities such as cardiac axis deviation, conduction abnormalities and ST-segment, and T &P wave abnormalities have been reported in patients with pectus excavatum. The precise determinants of these electrocardiographic abnormalities have however not been systematically evaluated. We therefore carried out this exploratory study to assess the electrocardiographic abnormalities and their determinants in children and young adults with pectus excavatum. METHODS Patients aged between 6 and 22 years with unrepaired pectus excavatum were eligible for enrollment in this preliminary hypothesis generating study, if they were seen at University of Chicago Medical Center between Jan 1, 2017 to Nov 30, 2020, and underwent an electrocardiogram during comprehensive evaluation for pectus excavatum. Pertinent data was collected from the medical charts. Unadjusted and adjusted logistic regression models were used to determine the effect of variables including age, BMI, inspiratory Haller's index, gender, right ventricular geometric distortion and FEV1/FVC (% predicted) on odds of electrocardiographic abnormalities (primary outcome variable). P-values of <0.05 were considered significant. RESULTS The study group (16.6 ± 2.9 years, 80% symptomatic) consisted of 28 patients [Caucasian, male (n = 24, 86% each)]. A high proportion (86%) of these patients had geometric distortion of the right ventricle on noninvasive imaging and these patients had a higher Haller's index (4.4 ± 0.95 vs 3.3 ± 0.2, p = 0.03). Approximately 60% of the patients had an abnormal electrocardiogram. Unadjusted and adjusted logistic regression models were utilized to study the determinants of these electrocardiographic abnormalities. Haller's index, BMI, age, gender, geometric distortion of the right ventricle and lung function parameters [FEV1/FEV (% predicted)] were not associated with increased odds of electrocardiographic abnormalities. CONCLUSIONS Electrocardiographic abnormalities, particularly deviation of cardiac axis, are common in patients with pectus excavatum. In this exploratory hypothesis generating study, Haller's index and geometric distortion of the right ventricle were not associated with these abnormalities. However, systematic multicentric efforts are needed to better define electrocardiographic abnormalities in patients with pectus excavatum and elucidate their precise determinants.
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Padalino MA, Franchetti N, Hazekamp M, Sojak V, Carrel T, Frigiola A, Lo Rito M, Horer J, Roussin R, Cleuziou J, Meyns B, Fragata J, Telles H, Polimenakos AC, Francois K, Veshti A, Salminen J, Rocafort AG, Nosal M, Vedovelli L, Guariento A, Vida VL, Sarris GE, Boccuzzo G, Stellin G. Surgery for anomalous aortic origin of coronary arteries: a multicentre study from the European Congenital Heart Surgeons Association†. Eur J Cardiothorac Surg 2020; 56:696-703. [PMID: 30897195 DOI: 10.1093/ejcts/ezz080] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/11/2019] [Accepted: 02/03/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES We sought to describe early and late outcomes in a large surgical series of patients with anomalous aortic origin of coronary arteries. METHODS We performed a retrospective multicentre study including surgical patients with anomalous aortic origin of coronary arteries since 1991. Patients with isolated high coronary takeoff and associated major congenital heart disease were excluded. RESULTS We collected 156 surgical patients (median age 39.5 years, interquartile range 15-53) affected by anomalous right (67.9%), anomalous left (22.4%) and other anatomical abnormalities (9.6%). An interarterial course occurred in 86.5%, an intramural course in 62.8% and symptoms in 85.9%. The operations included coronary unroofing (56.4%), reimplantation (19.2%), coronary bypass graft (15.4%) and other (9.0%). Two patients with preoperative cardiac failure died postoperatively (1.3%). All survivors were discharged home in good clinical condition. At a median follow-up of 2 years (interquartile range 1-5, 88.5% complete), there were 3 deaths (2.2%), 9 reinterventions in 8 patients (5 interventional, 3 surgical); 91.2% are in New York Heart Association functional class ≤ II, but symptoms persisted in 14.2%; 48.1% of them returned to sport activity. On Kaplan-Meier analysis, event-free survival at follow-up was 74.6%. Morbidity was not significantly different among age classes, anatomical variants and types of surgical procedures. Furthermore, return to sport activity was significantly higher in younger patients who participated in sports preoperatively. CONCLUSIONS Surgical repair of anomalous aortic origin of coronary arteries is effective and has few complications. Unroofing and coronary reimplantation are safe and are the most common procedures. The occurrence of late adverse events is not negligible, and long-term surveillance is mandatory. Most young athletes can return to an unrestrained lifestyle.
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Affiliation(s)
- Massimo A Padalino
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Padova, Italy
| | - Nicola Franchetti
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Padova, Italy
| | | | | | - Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Frigiola
- Division of Cardiac Surgery, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Mauro Lo Rito
- Division of Cardiac Surgery, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Jurgen Horer
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | - Regine Roussin
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | | | - Bart Meyns
- Department of Cardiovascular Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jose Fragata
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta, Lisbon, Portugal
| | - Helena Telles
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta, Lisbon, Portugal
| | - Anastasios C Polimenakos
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, Augusta, GA, USA
| | - Katrien Francois
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Altin Veshti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Jukka Salminen
- Department of Pediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | | | - Matej Nosal
- Department of Pediatric Cardiac Surgery, National Institute of Cardio-Vascular Diseases-Childrens Heart Center, Bratislava, Slovakia
| | - Luca Vedovelli
- PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Alvise Guariento
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Padova, Italy
| | - Vladimiro L Vida
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Padova, Italy
| | - George E Sarris
- Athens Heart Surgery Institute and Iaso Children's Hospital, Athens, Greece
| | - Giovanna Boccuzzo
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Giovanni Stellin
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Padova, Italy
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8
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Yerebakan C, Ozturk M, Mota L, Sinha L, Gordish-Dressman H, Jonas R, Sinha P. Complete unroofing of the intramural coronary artery for anomalous aortic origin of a coronary artery: The role of commissural resuspension? J Thorac Cardiovasc Surg 2019; 158:208-217.e2. [PMID: 30955961 DOI: 10.1016/j.jtcvs.2019.01.140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 01/12/2019] [Accepted: 01/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although surgical repair of an anomalous aortic origin of the coronary artery has low operative mortality, longer-term risk of ischemia and aortic regurgitation remains concerning. We routinely perform aortic commissure resuspension after unroofing and sought to evaluate the outcomes with regard to aortic valve competence, symptoms, and signs of ischemia with this approach. METHODS Twenty-six consecutive patients who received the unroofing procedure for anomalous aortic origin of the coronary artery (10 left; 16 right) between 2004 and 2016 were reviewed. In addition to complete unroofing of the intramural coronary, patients early in the cohort (n = 9) received unroofing only, and aortic commissural resuspension was performed routinely in the subsequent patients (n = 17). Outcomes between commissural resuspension versus no commissural resuspension were compared. The occurrence of mild and greater aortic regurgitation was assessed using a time-to-event analysis after varying lengths of time. Commissural resuspension was considered as the predictor, and the groups were compared using a log-rank test. RESULTS There was no operative mortality. One patient in the no commissural resuspension group died 10 years later of prosthetic aortic valve endocarditis (aortic valve replacement 7 years after unroofing). The follow-up duration was 6.9 years (4.9-9.1) and 3.7 years (2.1-4.3) in the no commissural resuspension and commissural resuspension groups, respectively (P = .001). Available postoperative exercise stress test data (n = 14) revealed that 50% had an endurance level at the 25th percentile or greater for age. After a median follow-up of 1.9 years (3 months to 10.6 years), no patient in the commissural resuspension group had aortic regurgitation, whereas 6 of 9 patients (67%) in the no commissural resuspension group had stable but mild or greater aortic regurgitation. Time-to-event analysis with the primary event of occurrence of mild or greater aortic regurgitation showed significantly higher freedom from the occurrence of aortic regurgitation in the commissural resuspension group (P = .035). CONCLUSIONS Surgical repair of an anomalous aortic origin of the coronary artery can be performed with excellent early and midterm outcomes. Routine commissural resuspension of the aortic valve may lead to a lower rate of aortic valve regurgitation without increasing the risk of ischemia.
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Affiliation(s)
- Can Yerebakan
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Mahmut Ozturk
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Lucas Mota
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Lok Sinha
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Heather Gordish-Dressman
- Center for Genetic Medicine Research, Children's Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Richard Jonas
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Pranava Sinha
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC.
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9
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Padalino MA, Franchetti N, Sarris GE, Hazekamp M, Carrel T, Frigiola A, Horer J, Roussin R, Cleuziou J, Meyns B, Fragata J, Telles H, Polimenakos AC, Francois K, Veshti A, Salminen J, Rocafort AG, Nosal M, Vedovelli L, Protopapas E, Tumbarello R, Merola A, Pegoraro C, Motta R, Boccuzzo G, Sojak V, Rito ML, Caldaroni F, Corrado D, Basso C, Stellin G. Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. Int J Cardiol 2019; 291:189-193. [PMID: 30772012 DOI: 10.1016/j.ijcard.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. METHODS This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. RESULTS Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p < 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p < 0.001). CONCLUSIONS Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.
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Affiliation(s)
- Massimo A Padalino
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy.
| | - Nicola Franchetti
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - George E Sarris
- Athens Heart Surgery Institute and Iaso Children's Hospital, Athens, Greece
| | - Mark Hazekamp
- Department for Cardiovascular Surgery, University Medical Center, Leiden, the Netherlands
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Jurgen Horer
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | - Regine Roussin
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | | | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jose Fragata
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta Lisbon, Portugal
| | - Helena Telles
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta Lisbon, Portugal
| | - Anastasios C Polimenakos
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, Augusta, GA, USA
| | - Katrien Francois
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Altin Veshti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Jukka Salminen
- Department of Pediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | | | - Matej Nosal
- Department of Pediatric Cardiac Surgery, National Institute of Cardio-Vascular Diseases - Childrens Heart Center, Bratislava, Slovakia
| | - Luca Vedovelli
- PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | | | | | - Assunta Merola
- Division of Pediatric Cardiology, Ospedale Brotzu, Cagliari, Italy
| | - Cinzia Pegoraro
- Division of Sport Medicine, Ospedale Ca Foncello, Treviso, Italy
| | - Raffaella Motta
- Radiology Clinic, University of Padova, Medical School, Italy
| | - Giovanna Boccuzzo
- Department of Statistics, University of Padova, Medical School, Italy
| | - Vladimir Sojak
- Department for Cardiovascular Surgery, University Medical Center, Leiden, the Netherlands
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Domenico Corrado
- Section of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - Cristina Basso
- Section of Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - Giovanni Stellin
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
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Reiner B, Oberhoffer R, Ewert P, Müller J. Quality of life in young people with congenital heart disease is better than expected. Arch Dis Child 2019; 104:124-128. [PMID: 29599167 DOI: 10.1136/archdischild-2017-314211] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/07/2018] [Accepted: 03/10/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Improved treatments for patients with congenital heart disease (CHD) have led to a growing interest in long-term functional outcomes such as health-related quality of life (HRQoL). Studies on HRQoL in children with CHD have contradicting results. Therefore, we compared HRQoL of children with CHD with that of current healthy peers and stratify CHD cases by severity and diagnostic subgroups. METHODS We included 514 patients (191 girls) aged 7-17 (12.9±3.1) years who were recruited at our institution between July 2014 and May 2017. The self-reported and age-adapted KINDL questionnaire was used to assess HRQoL. Patient data were compared with that of a recent control group of 734 healthy children (346 girls, 13.4±2.1 years). RESULTS Patients with CHD scored at least as high as healthy peers in HRQoL (CHD: 78.6±9.8; healthy: 75.6±10.1; P<0.001). After correction for sex and age, patients with CHD presented a 2.3-point higher HRQoL (P<0.001). The sex-specific and age-specific analyses showed that there were no differences between boys with and without CHD in childhood (P=0.255), but in adolescence, boys with CHD had on average 3.9-point higher scores (P=0.001), whereas girls with CHD had statistically higher HRQoL perception than healthy girls in childhood (4.2 points; P=0.003) and adolescence (4.2 points; P=0.005). There were no differences between the severity classes or diagnostic subgroups in the total HRQoL score or in the six subdomains. CONCLUSION The high HRQoL in young patients with CHD suggests that they can cope well with their disease burden. This holds true for all severity classes and diagnostic subgroups.
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Affiliation(s)
- Barbara Reiner
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jan Müller
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
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Anomalous Aortic Origin of the Coronary Arteries: A Novel Unroofing Technique in an Adult Cohort. Ann Thorac Surg 2018; 107:823-828. [PMID: 30312617 DOI: 10.1016/j.athoracsur.2018.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anomalous aortic origin of the coronary arteries (AAOCA) is associated with sudden cardiac death and frequently treated with unroofing of an intramural segment. Most reports on AAOCA are of patients less than 30 years of age. We have reviewed our "older" patients who have undergone surgical repair and report a novel unroofing technique. METHODS A retrospective review was conducted of 40 adult patients who underwent surgery for AAOCA from June 2005 to June 2016. Our surgical approach changed from traditional sharp excision to electrical fulguration of the shared intramural wall segment. We assessed our population for symptom relief, resolution of ischemia, and reintervention. More than 6 months of follow-up was available for 34 patients. RESULTS Mean age was 47.1 ± 11.6 years (range, 19 to 67); 17 patients were female. The coronary anomaly was right from left in 35 patients, left from right 4, and left coronary from noncoronary sinus in 1 patient. Thirty-nine of 40 patients were symptomatic, with two prior sudden cardiac arrests. Preoperatively, 22 of 31 patients tested positive for ischemia, including the asymptomatic. The operation was unroofing in 37 of 40 patients, 17 by sharp excision and 20 by electrical fulguration. There were no 30-day deaths or complications and no reinterventions. Isolated unroofing by fulguration required shorter cardiopulmonary bypass and cross-clamp times than excision: 39 versus 62 minutes (p = 0.02) and 28 versus 42 minutes (p = 0.02), respectively. At an average follow-up of 5.0 years, 28 of 34 patients reported symptomatic improvement. There were two unrelated late deaths. CONCLUSIONS Unroofing by sharp excision and by electrical fulguration were equally safe in the short term. Fulguration is technically easier and faster while still equally effective.
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12
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Sachdeva S, Frommelt MA, Mitchell ME, Tweddell JS, Frommelt PC. Surgical unroofing of intramural anomalous aortic origin of a coronary artery in pediatric patients: Single-center perspective. J Thorac Cardiovasc Surg 2018; 155:1760-1768. [DOI: 10.1016/j.jtcvs.2017.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/18/2017] [Accepted: 11/01/2017] [Indexed: 01/15/2023]
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14
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Abstract
Over several decades, much has been learned about the diverse physical impacts of exercise. Those who excel, such as elite athletes, have physiologic differences compared with the general population. There is a growing body of data suggesting that gender may play a role in these adaptations. Further, certain cardiac conditions may exhibit a gender predilection. This article explains the particular cardiac nuances of the female athlete.
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Affiliation(s)
- Shelby C White
- Division of Pediatric Cardiology, Department of Pediatrics, UVA Children's Hospital Heart Center, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA
| | - Jana M Goldberg
- Department of Cardiovascular Disease, Hospital of the University of Pennsylvania, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Robert W Battle
- Division of Pediatric Cardiology, University of Virginia Health System, University of Virginia, PO Box 800158, Charlottesville, VA 22908-0158, USA
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15
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Quality of life and exercise performance in unoperated children with anomalous aortic origin of a coronary artery from the opposite sinus of valsalva. Cardiol Young 2017; 27:895-904. [PMID: 27667028 DOI: 10.1017/s1047951116001542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Anomalous aortic origin of a coronary artery is a congenital cardiac condition that can be associated with increased risk of sudden death. To date, quality of life and exercise performance have not been evaluated in patients with this condition who do not undergo surgical repair. METHODS We carried out a cross-sectional analysis of patients with unoperated anomalous aortic origin of a coronary artery at our institution from 1 January, 2000 to 31 January, 2016. We prospectively assessed quality of life using standardised questionnaires. Medical records were reviewed for clinical and exercise stress test data. Statistical analyses were performed using Student's t-tests and Spearman's correlation coefficients. RESULTS In total, 56 families completed the questionnaires. The average age at enrolment was 14.7±6 years. The majority were male (n=44, 78.6%) and had interarterial anomalous right coronary artery (n=38, 67.9%). Patients had normal quality of life on the PedsQL 4.0 Report, Child Health Questionnaire Child Form 87, and SF-36v2. Their parents had normal quality of life on the PedsQL 4.0 Parent Report, but parents of exercise-restricted patients had decreased Physical Functioning, General Health Perception, Emotional Impact on Parent, and Physical Summary scores (p<0.001-0.048) on the Child Health Questionnaire Parent Form 50. CONCLUSIONS Patients with unoperated anomalous aortic origin of a coronary artery appear to have normal quality of life, but parents of exercise-restricted patients have decreased general health and emotional and physical quality of life scores. Improved counselling of families may be beneficial in this group. Future studies with more patients should evaluate quality of life and exercise performance over time.
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Brothers JA, Frommelt MA, Jaquiss RD, Myerburg RJ, Fraser CD, Tweddell JS. Expert consensus guidelines: Anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg 2017; 153:1440-1457. [DOI: 10.1016/j.jtcvs.2016.06.066] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023]
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Agrawal H, Wright OK, Carberry KE, Sexson Tejtel SK, Mery CM, Molossi S. Family perception of unmet support needs following a diagnosis of congenital coronary anomaly in children: Results of a survey. CONGENIT HEART DIS 2017; 12:721-725. [DOI: 10.1111/chd.12473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/12/2017] [Accepted: 04/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Hitesh Agrawal
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Oriana K. Wright
- McGovern Medical School at The University of Texas Health Science Center at Houston; Houston Texas
| | - Kathleen E. Carberry
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- Outcomes & Impact Services; Texas Children's Hospital; Houston Texas
| | - S. Kristen Sexson Tejtel
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Carlos M. Mery
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
| | - Silvana Molossi
- Coronary Anomalies Program; Texas Children's Hospital; Houston Texas
- The Lillie Frank Abercrombie Section of Cardiology; Texas Children's Hospital, Baylor College of Medicine; Houston Texas
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Mainwaring RD, Murphy DJ, Rogers IS, Chan FP, Petrossian E, Palmon M, Hanley FL. Surgical Repair of 115 Patients With Anomalous Aortic Origin of a Coronary Artery From a Single Institution. World J Pediatr Congenit Heart Surg 2017; 7:353-9. [PMID: 27142404 DOI: 10.1177/2150135116641892] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/06/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Anomalous aortic origin of a coronary artery (AAOCA) has been associated with myocardial ischemia and sudden death. The past decade has provided important insights into the natural history and typical patterns of presentation. However, there are also a number of unresolved controversies regarding the indications for surgery and the efficacy of that surgery. The purpose of this study was to review our surgical experience with AAOCA in 115 patients at a single institution. DESIGN One hundred and fifteen patients have undergone surgical repair of AAOCA at our institution. There were 82 males and 33 females, and the median age at surgery was 16 years. Fifty-nine patients had preoperative symptoms of myocardial ischemia, including 56 with exertional chest pain or syncope and 3 sudden death events. Twenty-four patients had associated congenital heart defects. Seven patients had an associated myocardial bridge. RESULTS Surgical repair was accomplished by unroofing of an intramural coronary in 86, reimplantation in 9, and pulmonary artery translocation in 20. There has been no early or late mortality. Fifty-seven (97%) of the 59 symptomatic patients have been free of any cardiac symptoms postoperatively. Two patients had recurrent symptoms and underwent reoperation (one had revision of the initial repair and one had repair of a myocardial bridge). CONCLUSIONS Surgical repair of AAOCA can be safely performed and is highly efficacious in relieving symptoms of myocardial ischemia. The two "surgical failures" in this series had an anatomic basis and underscore the need to reassess both the proximal and distal anatomy in these patients.
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Affiliation(s)
- Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Daniel J Murphy
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Ian S Rogers
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Frandics P Chan
- Division of Pediatric Radiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Edwin Petrossian
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Michal Palmon
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
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Law T, Dunne B, Stamp N, Ho KM, Andrews D. Surgical Results and Outcomes After Reimplantation for the Management of Anomalous Aortic Origin of the Right Coronary Artery. Ann Thorac Surg 2016; 102:192-8. [PMID: 27112655 DOI: 10.1016/j.athoracsur.2016.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 12/29/2015] [Accepted: 02/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Anomalous aortic origin of the right coronary artery (AAORCA) has been reported to cause myocardial ischemia, leading to angina, dyspnea, and decreased exercise tolerance. Reimplantation is a repair technique devised to exclude the abnormal intramural portion of the anomalous artery and avoid the known late attrition of saphenous vein grafts. Our study aims to evaluate the medium-term clinical outcomes with this technique. METHODS A retrospective review was made of patients who underwent repair of AAORCA by reimplantation between 2002 and 2014 in two institutions in Western Australia. Follow-up computed tomography coronary angiography was used to assess the status of the reimplanted right coronary artery (RCA). Data on survival, freedom from symptoms, cardiac events, and cardiac interventions were also analyzed. RESULTS Of the 16 patients (aged 17 to 70 years old), 14 (88%) were symptomatic before surgery, with angina (50%) and exertional dyspnea (56%) being the most common symptoms. Surgical reimplantation was successful in 15 patients (94%) without operative mortality. One patient required saphenous vein bypass grafting of the RCA intraoperatively after presumed failed repair and difficulty weaning from cardiopulmonary bypass. All patients who had successful reimplantation of AAORCA were symptom-free after surgery, and none had subsequent cardiac events attributable to the RCA or required further interventions. Ten patients (67%) had computed tomography coronary angiography after surgery; none had stenosis, kinking, or compression of the RCA by the pulmonary artery. Two further patients (including the patient who underwent saphenous vein grafting for presumed failed reimplantation) underwent conventional angiography, which demonstrated patent reimplantations. CONCLUSIONS To the best of our knowledge, this is the largest reported series of anomalous RCA managed by surgical reimplantation. Our results suggest that this technique is safe and has excellent medium to long-term results regarding symptom-free survival.
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Affiliation(s)
- Timothy Law
- Department of Cardiothoracic Surgery, Western Australian Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
| | - Ben Dunne
- Department of Cardiothoracic Surgery, Western Australian Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Nikki Stamp
- Department of Cardiothoracic Surgery, Western Australian Cardiothoracic Research and Audit Group, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Kwok M Ho
- Intensive Care Unit, Royal Perth Hospital, Perth, School of Population Health, University of Western Australia, and School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - David Andrews
- Department of Cardiac Surgery, Princess Margaret Hospital, Subiaco, Western Australia, Australia
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Quality of life in adolescents and young adults with CHD is not reduced: a systematic review and meta-analysis. Cardiol Young 2016; 26:415-25. [PMID: 26561207 DOI: 10.1017/s104795111500181x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We performed a systematic review and meta-analysis of observational studies assessing quality of life in adolescents and young adults born with CHD compared with age-matched controls. METHODS We carried out a systematic search of the literature published in Medline, Embase, PsychINFO, and the Cochrane Library's Database (1990-2013); two authors independently extracted data from the included studies. We used the Newcastle-Ottawa scale for quality assessment of studies. A random effects meta-analysis model was used. Heterogeneity was assessed using the I2-test. RESULTS We included 18 studies with 1786 patients. The studies were of acceptable-to-good quality. The meta-analysis of six studies on quality of life showed no significant difference - mean difference: -1.31; 95% confidence intervals: -6.51 to +3.89, I2=90.9% - between adolescents and young adults with CHD and controls. Similar results were found in 10 studies not eligible for the meta-analysis. In subdomains, it seems that patients had reduced physical quality of life; however, social functioning was comparable or better compared with controls. CONCLUSION For the first time in a meta-analysis, we have shown that quality of life in adolescents and young adults with CHD is not reduced when compared with age-matched controls.
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21
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Abstract
Anomalous origin of a coronary artery from the aorta is a potentially serious anomaly that occurs in about 0.1-0.2% of the population. This percentage is small; however, it translates into about 4000 annual births with these anomalies. The clinical presentation of these anomalies is rare, and hence most are and will remain asymptomatic. The various anatomic anomalies are described, with anomalous origin of the left coronary artery that then passes between the aorta and pulmonary artery being the most serious of these anomalies. The pathophysiology resulting from these anomalies is described, as are methods for identifying those who require treatment; however, we still do not know the best methods of determining which patients need treatment.
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Mellion K, Uzark K, Cassedy A, Drotar D, Wernovsky G, Newburger JW, Mahony L, Mussatto K, Cohen M, Limbers C, Marino BS. Health-related quality of life outcomes in children and adolescents with congenital heart disease. J Pediatr 2014; 164:781-788.e1. [PMID: 24412135 DOI: 10.1016/j.jpeds.2013.11.066] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 10/18/2013] [Accepted: 11/26/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare health-related quality of life (HRQOL) in a group of pediatric patients with congenital heart disease (CHD) and healthy controls and patients with other chronic diseases, and to compare HRQOL among patients with CHD of various severity categories with one another, with controls, and with patients with other chronic diseases. STUDY DESIGN In this cross-sectional survey, t tests were used to compare patient and proxy-reported Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) scores (including total, physical health, and psychosocial health summary scores) in children (aged 8-12 years) and adolescents (aged 13-18 years) between controls and (1) a composite CHD population; and (2) patients in each of 3 CHD severity categories: mild (no intervention), biventricle (BV; postintervention), and single ventricle (SV; postpalliation). PedsQL scores among CHD severity categories were compared by ANOVA. PedsQL scores were also compared in the CHD population and children with other chronic diseases without age stratification using t tests. RESULTS There were 1138 (children, n = 625; adolescents, n = 513) and 771 (children, n = 528; adolescents, n = 243) patient and/or proxy reporters in the CHD and healthy control groups, respectively. Total, physical health, and psychosocial health summary scores were lower in the composite CHD, BV, and SV groups compared with controls (P < .0001). There were significant differences among disease severity categories for all scores (P < .01). The composite CHD, BV, and SV groups had similar PedsQL scores as end-stage renal disease, asthma, and obesity populations. CONCLUSION Children and adolescents with BV and SV CHD have significantly lower HRQOL than healthy controls and similar HRQOL as patients with other chronic pediatric diseases. Interventions targeting both physical and psychosocial domains are needed to improve HRQOL in this high-risk population.
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Affiliation(s)
- Katelyn Mellion
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Karen Uzark
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Amy Cassedy
- Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dennis Drotar
- Division of Behavioral and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gil Wernovsky
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jane W Newburger
- Division of Cardiology, Department of Pediatrics, Children's Hospital Boston, Boston, MA
| | - Lynn Mahony
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center Dallas, Dallas, TX
| | - Kathy Mussatto
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Mitchell Cohen
- Department of Cardiology, Phoenix Children's Hospital, Phoenix, AZ
| | - Christine Limbers
- Department of Psychology and Neuroscience, Baylor University, Waco, TX
| | - Bradley S Marino
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Mainwaring RD, Reddy VM, Reinhartz O, Petrossian E, Punn R, Hanley FL. Surgical repair of anomalous aortic origin of a coronary artery. Eur J Cardiothorac Surg 2014; 46:20-6. [PMID: 24431169 DOI: 10.1093/ejcts/ezt614] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect that has been associated with myocardial ischaemia and sudden death. There is an ongoing controversy over the indications for surgical intervention and the efficacy of that treatment compared with the natural history. The purpose of this study was to evaluate the medium-term results of surgical repair of AAOCA. METHODS Seventy-six patients underwent surgical repair of AAOCA at our institution from 1999 to 2013. There were 55 males and 21 females, and the median age at surgery was 15 years. Forty-seven (62%) of the 76 patients had an anomalous right coronary artery, 27 had an anomalous left coronary and 2 had an eccentric single coronary ostia. Forty-one patients had preoperative symptoms of myocardial ischaemia. RESULTS Surgical repair was accomplished by unroofing of an intramural coronary in 55, reimplantation in 7 and pulmonary artery translocation in 14. There has been no early or late mortality, with a median duration of follow-up of 6 years. One patient presented with severe myocardial ischaemia and subsequently underwent heart transplantation a year following AAOCA surgery. The remaining patients have all remained free of cardiac symptoms. CONCLUSIONS The results of this study demonstrate two major principles. First, surgical repair of AAOCA is quite safe in centres that take care of a significant number of patients with this entity. Secondly, the surgery is highly effective in eliminating symptoms of myocardial ischaemia. The growing amount of data on postoperative patients suggests that surgical repair can prevent the adverse events seen in the untreated 'natural' history. Based on these observations, it is our current recommendation that all teenagers identified with AAOCA should undergo surgical repair.
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Affiliation(s)
- Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - V Mohan Reddy
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Olaf Reinhartz
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Oakland Children's Hospital, Oakland, CA, USA
| | - Edwin Petrossian
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Children's Hospital of Central California, Madera, CA, USA
| | - Rajesh Punn
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Oakland Children's Hospital, Oakland, CA, USA Division of Pediatric Cardiac Surgery, Children's Hospital of Central California, Madera, CA, USA
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24
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Wittlieb-Weber CA, Paridon SM, Gaynor JW, Spray TL, Weber DR, Brothers JA. Medium-term outcome after anomalous aortic origin of a coronary artery repair in a pediatric cohort. J Thorac Cardiovasc Surg 2013; 147:1580-6. [PMID: 23988284 DOI: 10.1016/j.jtcvs.2013.07.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 06/14/2013] [Accepted: 07/02/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Anomalous aortic origin of a coronary artery with an interarterial and intramural course (AAOCA) is a rare anomaly with increased risk of sudden cardiac death during or just after exercise among otherwise healthy youth. Risk stratification and management remain controversial, especially for the asymptomatic child with an anomalous right coronary artery from the left coronary sinus (ARCA). Medium-term surgical and quality-of-life (QOL) outcome data are lacking in this population. METHODS We performed medical record review on 24 subjects who underwent AAOCA repair between 2001 and 2007 at The Children's Hospital of Philadelphia. QOL was prospectively assessed with age-appropriate questionnaires. RESULTS Median age at follow-up was 18 (range, 11-25) years, median follow-up from surgery was 63 (range, 12-110) months, and 16 (67%) had ARCA. All were alive without exercise restriction. Thirteen (54%) complained of cardiac-type symptoms postoperatively, most commonly chest pain, none correlating with evidence of ischemia on testing. Of the 13 patients, 7 (54%) reported the same symptoms preoperatively; and of these, 5 had ARCA. Postoperative morbidity occurred in 16 (67%), including pericardial effusion (n = 11), wound infection (n = 2), and development of mild aortic insufficiency (n = 4). QOL questionnaires were sent to 21 subjects; 12 (57%) were returned. Average QOL was normal for all subjects. CONCLUSIONS In the medium-term after AAOCA repair, cardiac-type symptoms frequently persist and morbidity is common, but these do not impair QOL. The significance of these findings in the long-term is unknown and warrants continued follow-up.
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Affiliation(s)
| | - Stephen M Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Thomas L Spray
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - David R Weber
- Division of Endocrinology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Julie A Brothers
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa
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Dahan-Oliel N, Majnemer A, Mazer B. Quality of life of adolescents and young adults born at high risk. Phys Occup Ther Pediatr 2011; 31:362-89. [PMID: 21599571 DOI: 10.3109/01942638.2011.572151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Research on quality of life (QoL) of adolescents and young adults born preterm and those with congenital heart disease (CHD) was systematically reviewed, and factors associated with QoL were identified. Forty-five studies met the inclusion criteria for review. Although the majority of studies found that self-reported QoL of adolescents and young adults born preterm did not differ from term controls, several studies reported lower QoL among individuals born preterm, especially those who had additional impairments. Most studies on adolescents and young adults with CHD reported lower QoL compared with healthy peers, which may be in part due to real or perceived physical activity limitations of individuals with CHD. Overall, parents reported that their adolescents born at high risk had a less favorable QoL compared with those who served as controls. Encouraging age-appropriate, safe, and enjoyable physical activity and avoiding unnecessary restrictions and overprotection are considerations for optimizing QoL.
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Affiliation(s)
- Noémi Dahan-Oliel
- School of Physical and Occupational Therapy, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada.
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Anomalous Aortic Origin of a Coronary Artery: Medium-Term Results After Surgical Repair in 50 Patients. Ann Thorac Surg 2011; 92:691-7. [DOI: 10.1016/j.athoracsur.2011.03.127] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 11/21/2022]
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Discovery of a symptomatic left anomalous coronary artery from the opposite sinus and postoperative considerations. Case Rep Med 2009; 2009:509064. [PMID: 19841756 PMCID: PMC2762240 DOI: 10.1155/2009/509064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/02/2009] [Indexed: 12/01/2022] Open
Abstract
This is the case of an 18 year old active duty soldier with
symptoms of exertional chest pressure and syncope who was found to
have anomalous origin of the left main coronary artery (LMCA) from
the right coronary cusp (RCC) traveling partially between the
great vessels before taking a septal approach between the left
ventricular outflow tract (LVOT) and the right ventricular outflow
tract (RVOT). Anomalous origin of coronary arteries is a rare
condition that carries an increased risk of angina, myocardial
ischemia, and sudden cardiac death (SCD). Surgical treatment of
such anomalies with both high and lower risk features can be
challenging, and traditional benefit from surgical correction may
not be achieved due to complex anatomy. As evident by our patient,
this rare condition even though benign from sudden death
standpoint could be debilitating despite best efforts and
available resources.
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