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Dean PN, Brothers JA, Burns K, Edelson JB, Etheridge S, Phelan DM, Shafer K, Snyder C, Molossi S, Danielian A, Friedman EM, Hsu J, Husaini M, Chung EH, Martinez MW, Baggish AL, Levine BD, Kim JH. The Cardiovascular Care of the Pediatric Athlete. J Am Coll Cardiol 2025; 85:1434-1454. [PMID: 40175017 DOI: 10.1016/j.jacc.2025.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/04/2025] [Accepted: 02/06/2025] [Indexed: 04/04/2025]
Abstract
Sports cardiology broadly encompasses the cardiovascular care of individuals who place a high premium on habitual exercise, sports performance, and/or sports competition. Some of the essential aspects within sports cardiology include the preparticipation cardiac evaluation and the management of cardiac diseases in athletes. Although most sports cardiology practitioners are trained in adult cardiology, a significant number of individuals who participate in sports are pediatric-aged, <18 years old. Up to two-thirds of children in middle and high school participate in organized sports or are involved in nonorganized recreational sports. The cardiovascular care of pediatric-aged athletes can be challenging because many of the classic tenets and principles in adult sports cardiology do not fully generalize to pediatrics, and there is a lack of the evidence base that may be present for adult athletes. The epidemiology, presentation, and progression of cardiovascular diseases can be significantly different between pediatric and adult athletes. The evaluation of potential diseases and management considerations may also differ between pediatric and adult athletes. Similar to adults, there are "gray zones" where it is difficult to differentiate between normal exercise-induced cardiac remodeling and true cardiac pathology, but the additional lack of normative standards further complicates assessments in pediatric athletes. Management decisions for pediatric athletes are generally based on limited data but carry substantial short- and long-term implications. Thus, shared decision-making as part of the determination of clinical management strategies and for sports participation is critical and requires the participation of the parents or guardian(s). In this state-of-the-art review, key differences between pediatric and adult-aged athletes are highlighted. Specifically, how to define the "pediatric athlete," consider cardiovascular adaptations observed among pediatric athletes, determine preparticipation screening options and optimal symptom-driven evaluations in children, and consider best practices for pediatric athletes with several key cardiac conditions are detailed. The purpose of this document is to represent the first primary reference available to providers who care for pediatric athletes with cardiovascular concerns.
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Affiliation(s)
- Peter N Dean
- Department of Pediatrics, Division of Pediatric Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Julie A Brothers
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristin Burns
- Children's National Health System and the National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan B Edelson
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Dermot M Phelan
- Gragg Center for Cardiovascular Performance, Atrium Health, Sanger Heart & Vascular Institute, Charlotte, North Carolina, USA
| | - Keri Shafer
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chris Snyder
- Children's Hospital of Richmond, Richmond, Virginia, USA
| | - Silvana Molossi
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Alfred Danielian
- Division of Sports Cardiology, Las Vegas Heart Associates, Las Vegas, Nevada, USA
| | - Eli M Friedman
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Jeff Hsu
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Mustafa Husaini
- Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Eugene H Chung
- Cardiovascular Performance Program and Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew W Martinez
- Sports Cardiology & Hypertrophic Cardiomyopathy Center, Atlantic Health System, Morristown Medical Center, Morristown, New Jersey, USA
| | - Aaron L Baggish
- Department of Cardiology, University of Lausanne, Lausanne, Switzerland
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, Texas, USA; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
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Kim JH, Baggish AL, Levine BD, Ackerman MJ, Day SM, Dineen EH, Guseh JS, La Gerche A, Lampert R, Martinez MW, Papadakis M, Phelan DM, Shafer KM. Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2025; 151:e716-e761. [PMID: 39973614 DOI: 10.1161/cir.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
COLLABORATORS Larry A. Allen, MD, MHS, FAHA, FACC; Mats Börjesson, MD, PhD, FACC; Alan C. Braverman, MD, FACC; Julie A. Brothers, MD; Silvia Castelletti, MD, MSc, FESC; Eugene H. Chung, MD, MPH, FHRS, FAHA, FACC; Timothy W. Churchill, MD, FACC; Guido Claessen, MD, PhD; Flavio D'Ascenzi, MD, PhD; Douglas Darden, MD; Peter N. Dean, MD, FACC; Neal W. Dickert, MD, PhD, FACC; Jonathan A. Drezner, MD; Katherine E. Economy, MD, MPH; Thijs M.H. Eijsvogels, PhD; Michael S. Emery, MD, MS, FACC; Susan P. Etheridge, MD, FHRS, FAHA, FACC; Sabiha Gati, BSc (Hons), MBBS, PhD, MRCP, FESC; Belinda Gray, BSc (Med), MBBS, PhD; Martin Halle, MD; Kimberly G. Harmon, MD; Jeffrey J. Hsu, MD, PhD, FAHA, FACC; Richard J. Kovacs, MD, FAHA, MACC; Sheela Krishnan, MD, FACC; Mark S. Link, MD, FHRS, FAHA, FACC; Martin Maron, MD; Silvana Molossi, MD, PhD, FACC; Antonio Pelliccia, MD; Jack C. Salerno, MD, FACC, FHRS; Ankit B. Shah, MD, MPH, FACC; Sanjay Sharma, BSc (Hons), MBChB, MRCP (UK), MD; Tamanna K. Singh, MD, FACC; Katie M. Stewart, NP, MS; Paul D. Thompson, MD, FAHA, FACC; Meagan M. Wasfy, MD, MPH, FACC; Matthias Wilhelm, MD. This American Heart Association/American College of Cardiology scientific statement on clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities or diseases is organized into 11 distinct sections focused on sports-specific topics or disease processes that are relevant when considering the potential risks of adverse cardiovascular events, including sudden cardiac arrest, during competitive sports participation. Task forces comprising international experts in sports cardiology and the respective topics covered were assigned to each section and prepared specific clinical considerations tables for practitioners to reference. Comprehensive literature review and an emphasis on shared decision-making were integral in the writing of all clinical considerations presented.
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Kim JH, Baggish AL, Levine BD, Ackerman MJ, Day SM, Dineen EH, Guseh Ii JS, La Gerche A, Lampert R, Martinez MW, Papadakis M, Phelan DM, Shafer KM, Allen LA, Börjesson M, Braverman AC, Brothers JA, Castelletti S, Chung EH, Churchill TW, Claessen G, D'Ascenzi F, Darden D, Dean PN, Dickert NW, Drezner JA, Economy KE, Eijsvogels TMH, Emery MS, Etheridge SP, Gati S, Gray B, Halle M, Harmon KG, Hsu JJ, Kovacs RJ, Krishnan S, Link MS, Maron M, Molossi S, Pelliccia A, Salerno JC, Shah AB, Sharma S, Singh TK, Stewart KM, Thompson PD, Wasfy MM, Wilhelm M. Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2025; 85:1059-1108. [PMID: 39976316 DOI: 10.1016/j.jacc.2024.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
This American Heart Association/American College of Cardiology scientific statement on clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities or diseases is organized into 11 distinct sections focused on sports-specific topics or disease processes that are relevant when considering the potential risks of adverse cardiovascular events, including sudden cardiac arrest, during competitive sports participation. Task forces comprising international experts in sports cardiology and the respective topics covered were assigned to each section and prepared specific clinical considerations tables for practitioners to reference. Comprehensive literature review and an emphasis on shared decision-making were integral in the writing of all clinical considerations presented.
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Przybycien TS, Gray K, Sidiq S, Mihail S, Doan TT, Sachdeva S, Reaves-O'Neal D, Binsalamah Z, Molossi S. Characterising the lipid profile of paediatric patients with anomalous aortic origins of a coronary artery. Cardiol Young 2025; 35:311-316. [PMID: 39568195 DOI: 10.1017/s1047951124035996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2024]
Abstract
BACKGROUND Lipid levels in paediatric patients with anomalous aortic origin of a coronary artery (AAOCA) have not previously been explored. Patients with CHD have an increased risk of atherosclerotic cardiovascular disease later in life compared to the general population. We aim to characterise the lipid profiles in paediatric patients with AAOCA and explore its relation to diagnosis, race/ethnicity, and exercise. METHODS Single institution retrospective cohort of 180 AAOCA paediatric patients (median age 13.7 years interquartile range 9.7-15.6, 66% male). Total cholesterol, HDL, LDL, triglycerides, total cholesterol to HDL ratio, and non-HDL cholesterol were evaluated across race/ethnicity, sex, type of AAOCA, documented ischaemia on imaging, exercise level, and surgery status. Normality of the data distribution for each lipid parameter was evaluated using Kolmogorov-Smirnov testing. Accordingly, Mann-Whitney U and t-tests were used to compare variables. The proportion of abnormal lipid levels by sex and race/ethnicity was calculated. RESULTS Total cholesterol was elevated in 29%, (51/177) of patients, HDL 37% (64/174), triglycerides 44% (72/165), LDL 16% (28/170), total cholesterol-HDL ratio 29%, (48/163), and non-HDL cholesterol 28% (47/165). Across subgroups categorised on the basis of surgery status, exercise level, AAOCA type, and sex, the mean and median levels for individual lipid parameters were normal. By race/ethnicity, Hispanic patients had significantly higher triglyceride (median 99, interquartile range 71-136.5, p = <0.001) and total cholesterol to HDL ratios (median 3.2, interquartile range 2.7-4.5, p = 0.014) versus non-Hispanic White and Black patients. Two-thirds of patients exercise recreationally. CONCLUSION Hispanic patients have significantly elevated triglycerides and total cholesterol to HDL ratios compared to others. Longitudinal follow-up evaluating differences in long-term lipid status in patients with AAOCA and risk for cardiovascular events is warranted.
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Affiliation(s)
- Thomas S Przybycien
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Kimberly Gray
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | | | | | - Tam T Doan
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Shagun Sachdeva
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Dana Reaves-O'Neal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | | | - Silvana Molossi
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
- Coronary Artery Anomalies Program, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Houston, Texas, USA
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Puelz C, Rusin CG, Lior D, Sachdeva S, Doan TT, Eilers LF, Reaves-O'Neal D, Akula M, Molossi S. Fluid-structure interaction simulations for the prediction of fractional flow reserve in pediatric patients with anomalous aortic origin of a coronary artery. Med Eng Phys 2025; 136:104293. [PMID: 39979010 DOI: 10.1016/j.medengphy.2025.104293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 01/02/2025] [Accepted: 01/08/2025] [Indexed: 02/22/2025]
Abstract
Computer simulations of blood flow in patients with anomalous aortic origin of a coronary artery (AAOCA) have the promise to provide insight into this complex disease. They provide an in silico experimental platform to explore possible mechanisms of myocardial ischemia, a potentially deadly complication for patients with this defect. This paper focuses on the question of model calibration for fluid-structure interaction models of pediatric AAOCA patients. Imaging and cardiac catheterization data provide partial information for model construction and calibration. However, parameters for downstream boundary conditions needed for these models are difficult to estimate. Further, important model predictions, like fractional flow reserve (FFR), are sensitive to these parameters. We describe an approach to calibrate downstream boundary condition parameters to clinical measurements of resting FFR. The calibrated models are then used to predict FFR at stress, an invasively measured quantity that can be used in the clinical evaluation of these patients. We find reasonable agreement between the model predicted and clinically measured FFR at stress, indicating the credibility of this modeling framework for predicting hemodynamics of pediatric AAOCA patients. This approach could lead to important clinical applications since it may serve as a tool for risk stratifying children with AAOCA.
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Affiliation(s)
- Charles Puelz
- Department of Mathematics, University of Houston, United States of America; Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America.
| | - Craig G Rusin
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
| | - Dan Lior
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
| | - Shagun Sachdeva
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
| | - Tam T Doan
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
| | - Lindsay F Eilers
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
| | - Dana Reaves-O'Neal
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
| | - Monisha Akula
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
| | - Silvana Molossi
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital, United States of America
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Molossi S, Sachdeva S. Advice to Young Athletes With Anomalous Aortic Origin of a Coronary Artery With and Without Surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2025; 28:83-93. [PMID: 40382130 DOI: 10.1053/j.pcsu.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 01/13/2025] [Accepted: 01/18/2025] [Indexed: 05/20/2025]
Abstract
Congenital coronary artery anomalies remain a leading cause of sudden cardiac death in the young. Within these, anomalous aortic origin of a coronary artery represents the largest group, with anomalies of the left coronary artery carrying higher risk for sudden cardiac arrest and clinical manifestations of myocardial ischemia. In contrast, anomalies of origin of the right coronary artery are more common and generally have a more benign clinical course, though rarely also associated with sudden events and myocardial ischemia. Risk stratification to guide management decisions remains to be well defined, though substantial advances have occurred in the last few years, with assessment of myocardial perfusion under provocative stress being an integral part of the evaluation in the young. Discussion and counseling on exercise behavior is essential to foster healthy lifestyle for these patients, acknowledging shared decision-making should be practiced in lieu of many unanswered questions as to outcomes long-term.
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Affiliation(s)
- Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas; The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| | - Shagun Sachdeva
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Texas; The Lillie Frank Abercrombie Division of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Jin T, Wang R, Dong L, Lv Y. Case Report: Recurrent cardiogenic shock caused by inter-arterial left coronary artery originating from the right coronary sinus, successfully rescued by mechanical circulatory support. Front Cardiovasc Med 2025; 11:1466524. [PMID: 39830007 PMCID: PMC11739284 DOI: 10.3389/fcvm.2024.1466524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 11/04/2024] [Indexed: 01/22/2025] Open
Abstract
A young female patient suffered cardiogenic shock after undergoing surgery for an ectopic pregnancy. Coronary artery computed tomography angiography (CTA) revealed a left main artery (LM) originating from the right coronary sinus and traveling between the aorta and pulmonary artery. We successfully resuscitated the patient with mechanical circulatory support using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). The patient subsequently underwent surgery thereafter. When sudden cardiogenic shock occurs in a young patient, it is important to be vigilant for anomalous aortic origin of a coronary artery (AAOCA).
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Affiliation(s)
- Tietuo Jin
- Department of Intensive Care Medicine, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Rui Wang
- Department of Dermatology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Liang Dong
- Department of Intensive Care Medicine, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Yvhang Lv
- Department of Intensive Care Medicine, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
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Malone LJ, Jadhav SP, Han BK, Sachdeva S. Imaging of common coronary artery anomalies and imaging features important for clinical decision-making. Pediatr Radiol 2024:10.1007/s00247-024-06135-9. [PMID: 39704826 DOI: 10.1007/s00247-024-06135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 11/01/2024] [Accepted: 12/01/2024] [Indexed: 12/21/2024]
Abstract
Anomalous coronary arteries are associated with sudden cardiac death, although only in a relatively small percentage. Although this has been a field of study for years and there are many ongoing studies of larger patient cohorts and longer term follow-up, important questions remain at present in clinical decision-making, particularly whether or not to have surgery. Advanced imaging techniques including coronary computed tomography (CT) and cardiac magnetic resonance (MR) play an important role in the workup of patients with known or suspected anomalies including delineating origin and course as well as defining presence of high-risk imaging features. Multidisciplinary decision-making is important when considering whether patients might need to undergo surgery. This review will describe types of anomalies, imaging techniques, and features as well as types of surgeries and postoperative imaging with highlights of imaging and surgical literature and several case examples.
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Affiliation(s)
- LaDonna J Malone
- Department of Radiology, Children's Hospital of Colorado, University of Colorado, 13123 E 16th Ave B125, Aurora, CO, 80045, USA.
| | - Siddharth P Jadhav
- Edward Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - B Kelly Han
- Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Shagun Sachdeva
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Mihail S, Doan TT, Przybycien TS, Gray K, Sidiq S, Sachdeva S, Reaves-O'Neal D, Dolgner S, Molossi S. Perceptions of exercise behavior and well-being in anomalous aortic origin of coronary arteries. Eur J Pediatr 2024; 183:4541-4551. [PMID: 39155320 DOI: 10.1007/s00431-024-05733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/07/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden death in the young. Risk stratification and management decision-making remain challenging. Data addressing post-diagnosis perceptions of exercise behavior and safety are lacking. We aimed to determine how AAOCA affects exercise behaviors, safety perceptions, and emotional well-being of patients/parents. Qualitative and quantitative analysis of AAOCA patient-/parent-specific survey was conducted to examine exercise frequency/restrictions, perceived safety of competitive/recreational exercise, and psychosocial well-being. Subgroups stratified by AAOCA subtype, surgical intervention, and physician-driven restrictions were compared using chi-squared and Fisher's exact tests. Cohen's kappa determined agreement in parent/child responses. AAOCA subtypes included 13 (24%) left AAOCA, 36 (67%) right AAOCA, and 5 (9%) other/unknown. Of 54 parents and 41 paired child responses, 22% of patients were physician-restricted from exercise. Parents imposed restrictions on competitive/recreational exercise 34%/26% of the time, respectively. Children without physician restrictions still self-restricted exercise 35% of the time. Parents reported feeling their child was unsafe exercising 61% competitively and 33% recreationally. Twenty-two percent of children reported feeling unsafe exercising, with good agreement to parental perceptions of competitive exercise safety (kappa = 0.779, p < 0.001). One-third of parents and children reported feeling sad, angry, or lonely, and about half reported feeling different. Importantly, 47% of children desired to exercise more. No difference was seen across restriction status, AAOCA subtype, or surgical management strategy. CONCLUSION There are different perceptions of exercise behavior and safety following AAOCA evaluation, regardless of risk category or management strategy, impacting their well-being. These unmet needs should be at the forefront of care. WHAT IS KNOWN • AAOCA is one of the leading causes of sudden cardiac death in the young. • Exercise restriction varies according to AAOCA subtype and its perceived risk of inducing myocardial ischemia. WHAT IS NEW • There are different perceptions of exercise behavior and safety in patients and parents following a diagnosis of AAOCA, impacting their well-being. • Risk category or management strategy has no effect in patients' and parents' perception of exercise safety. • These unmet needs in this population should be at the forefront of care.
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Affiliation(s)
| | - Tam T Doan
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA
| | - Thomas S Przybycien
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kimberly Gray
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | - Shagun Sachdeva
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA
| | - Dana Reaves-O'Neal
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA
| | - Stephen Dolgner
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA
| | - Silvana Molossi
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
- Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX, 77030, USA.
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10
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Doan TT, Puelz C, Rusin C, Molossi S. Anomalous Aortic Origin of a Coronary Artery in Pediatric Patients. CURRENT PEDIATRICS REPORTS 2024; 12:69-80. [PMID: 39816672 PMCID: PMC11729077 DOI: 10.1007/s40124-024-00317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 01/18/2025]
Abstract
Purpose of Review We present a contemporary approach to risk assessment and management of patients with anomalous aortic origin of a coronary artery (AAOCA). Recent Findings Anomalous left coronary artery from the right aortic sinus (L-AAOCA) with interarterial course carries a high risk of sudden cardiac death (SCD); therefore, current guidelines recommend exercise restriction and surgical intervention. Recent data in intraseptal and juxtacommissural L-AAOCA showed inducible perfusion abnormalities, leading to consideration of surgical intervention. Anomalous right coronary artery from the left aortic sinus (R-AAOCA) carries a much lower risk and stress perfusion imaging is helpful in identifying patients with inducible ischemia. Perfusion abnormalities resolve following successful surgical intervention of AAOCA. Computational modeling techniques identifying risk features shows promise in the evaluation of AAOCA. Summary Stress perfusion imaging is helpful in assessing AAOCA upon presentation and following surgical intervention. Computational modeling has potential in bridging knowledge gaps in AAOCA. Supplementary Information The online version contains supplementary material available at 10.1007/s40124-024-00317-7.
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Affiliation(s)
- Tam T. Doan
- Coronary Artery Anomalies Program, Division of Cardiology, Texas Children’s Hospital, 6651 Main Street MC-E1920, Houston, TX 77030 USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030 USA
| | - Charles Puelz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030 USA
| | - Craig Rusin
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030 USA
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Division of Cardiology, Texas Children’s Hospital, 6651 Main Street MC-E1920, Houston, TX 77030 USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030 USA
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Burns J, Emeruwa E, Connell P, Borges N, Reaves-O'Neal D, Molossi S. High-Risk Anomalous Aortic Origin of the Left Coronary Artery: Consecutive Admissions Presenting With Sudden Cardiac Arrest. World J Pediatr Congenit Heart Surg 2024; 15:349-352. [PMID: 38632690 DOI: 10.1177/21501351241237945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Anomalous aortic origin of the left coronary artery (AAOLCA) confers high risk for sudden cardiac arrest (SCA). This series aims to describe consecutive admissions with interarterial AAOLCA presenting with SCA and distinct clinical trajectories. An eight-year-old boy collapsed at school and received 10-min of cardiopulmonary resuscitation (CPR) and defibrillation prior to return of spontaneous circulation. He had no end-organ dysfunction and underwent uneventful coronary unroofing. In contrast, a 14-year-old boy presented with collapse while jogging. He received 40-min of CPR prior to extracorporeal membranous oxygenation cannulation with multisystem dysfunction and persistent severely depressed left ventricular function. He is now rehabilitating following uneventful orthotropic heart transplantation. These cases illustrate the diverse outcomes of AAOLCA with SCA following exertional syncope.
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Affiliation(s)
- Joseph Burns
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ezinne Emeruwa
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Patrick Connell
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Nirica Borges
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dana Reaves-O'Neal
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Silvana Molossi
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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12
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Allison EL, Lin KS, Bukharovich I. Anomalous Right Coronary Artery Clinical Presentations and Considerations. Cureus 2024; 16:e57207. [PMID: 38681396 PMCID: PMC11056208 DOI: 10.7759/cureus.57207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Anomalous coronary artery presenting as syncope or acute decompensated heart failure complicated by cardiogenic shock is a relatively rare finding. Here, two unusual presentations are described in which an anomalous right coronary artery (RCA) with interarterial course was found following an initially negative workup. The first case describes a 71-year-old male with known non-ischemic cardiomyopathy presenting with acute decompensated heart failure and cardiogenic shock. The second case highlights a 44-year-old female presenting with intermittent angina and recurrent syncope of unknown etiology. These two cases suggest that the anatomy of coronary arteries and their anatomical variants may play a crucial role in the development of adverse cardiovascular outcomes. Utilizing cardiac computed tomography angiography with a lower threshold in patients presenting with cardiac signs, symptoms, and risk factors would lead to earlier detection of these anatomic anomalies and intervention either medically or surgically for potentially improved long-term outcomes.
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Affiliation(s)
- Elizabeth L Allison
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Kai Shiang Lin
- Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, USA
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13
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Gaudino M, Di Franco A, Arbustini E, Bacha E, Bates ER, Cameron DE, Cao D, David TE, De Paulis R, El-Hamamsy I, Farooqi KM, Girardi LN, Gräni C, Kochav JD, Molossi S, Puskas JD, Rao SV, Sandner S, Tatoulis J, Truong QA, Weinsaft JW, Zimpfer D, Mery CM. Management of Adults With Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review. Ann Thorac Surg 2023; 116:1124-1141. [PMID: 37855783 DOI: 10.1016/j.athoracsur.2023.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/20/2023]
Abstract
As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a systematic review and critical evaluation of the available evidence on the interventional treatment of AAOCA in adult patients. Using a structured Delphi process, the group agreed on expert recommendations that are intended to complement existing clinical practice guidelines.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, IRCCS and Polyclinic San Matteo Foundation, Pavia, Italy
| | - Emile Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Eric R Bates
- Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Tirone E David
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy; UniCamillus University, Rome, Italy
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan D Kochav
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Silvana Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sunil V Rao
- Division of Interventional Cardiology, NYU Langone Health, New York, New York
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Quynh A Truong
- Department of Radiology, New York Presbyterian, Weill Cornell Medicine, New York, New York
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School at The University of Texas at Austin/Dell Children's Medical Center, Austin, Texas
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14
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Gaudino M, Di Franco A, Arbustini E, Bacha E, Bates ER, Cameron DE, Cao D, David TE, De Paulis R, El-Hamamsy I, Farooqi KM, Girardi LN, Gräni C, Kochav JD, Molossi S, Puskas JD, Rao SV, Sandner S, Tatoulis J, Truong QA, Weinsaft JW, Zimpfer D, Mery CM. Management of Adults With Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review. J Am Coll Cardiol 2023; 82:2034-2053. [PMID: 37855757 DOI: 10.1016/j.jacc.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 10/20/2023]
Abstract
As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a systematic review and critical evaluation of the available evidence on the interventional treatment of AAOCA in adult patients. Using a structured Delphi process, the group agreed on expert recommendations that are intended to complement existing clinical practice guidelines.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, IRCCS and Polyclinic San Matteo Foundation, Pavia, Italy
| | - Emile Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Eric R Bates
- Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Tirone E David
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy; UniCamillus University, Rome, Italy
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan D Kochav
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Silvana Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sunil V Rao
- Division of Interventional Cardiology, NYU Langone Health, New York, New York, USA
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Quynh A Truong
- Department of Radiology, New York Presbyterian, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School at The University of Texas at Austin/Dell Children's Medical Center, Austin, Texas, USA
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15
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Przybycien TS, Doan TT, Qureshi AM, Reaves-O'Neal D, Binsalamah Z, Molossi S. Invasive Coronary Assessment in a 9-Year-Old With Anomalous Aortic Origin of the Left Coronary Artery. World J Pediatr Congenit Heart Surg 2023; 14:746-748. [PMID: 37691340 DOI: 10.1177/21501351231185579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
A previously healthy nine-year-old boy with anomalous aortic origin of the left coronary artery (AAOLCA) with high-risk anatomy demonstrated negative stress on magnetic resonance imaging. Invasive cardiac catheterization for intracoronary flow measurement was performed and demonstrated compromised coronary flow during pharmacologic stress and significant stenosis on angiography. The patient underwent surgical intervention with normalization of coronary flow upon postoperative evaluation. Invasive intracoronary flow determination with angiography under provocative stress is emerging as a critical data point for risk stratification and management decision-making in high-risk AAOLCA patients with negative noninvasive perfusion studies.
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Affiliation(s)
- Thomas S Przybycien
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Tam T Doan
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dana Reaves-O'Neal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ziyad Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Silvana Molossi
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, TX, USA
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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