Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing.

Bigler, Marius Reto; Kadner, Alexander; Räber, Lorenz; Ashraf, Afreed; Windecker, Stephan; Siepe, Matthias; Padalino, Massimo Antonio; Gräni, Christoph (2022). Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing. Journal of the American Heart Association, 11(20), e027098. American Heart Association 10.1161/JAHA.122.027098

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Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are a challenge because of their various anatomic and clinical presentation. Although the prevalence is low, the absolute numbers of detected ACAOS are increasing because of the growing use of noninvasive anatomical imaging for ruling out coronary artery disease. As evidence-based guidelines are lacking, treating physicians are left in uncertainty for the optimal management of such patients. The sole presence of ACAOS does not justify surgical correction, and therefore a thorough anatomic and hemodynamic assessment is warranted. Invasive and noninvasive multimodality imaging provides information to the clinical question whether the presence of ACAOS is an innocent coincidental finding, is responsible for the patient's symptoms, or even might be a risk for sudden cardiac death. Based on recent clinical data, focusing on the pathophysiology of patients with ACAOS, myocardial ischemia is dependent on both the extent of fixed and dynamic components, represented by anatomic high-risk features. These varying combinations should be considered individually in the decision making for the different therapeutic options. This state-of-the-art review focuses on the advantages and limitations of the common contemporary surgical, interventional, and medical therapy with regard to the anatomy and pathophysiology of ACAOS. Further, we propose a therapeutic management algorithm based on current evidence on multimodality invasive and noninvasive imaging findings and highlight remaining gaps of knowledge.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Bigler, Marius Reto, Kadner, Alexander, Räber, Lorenz, Windecker, Stephan, Siepe, Matthias, Gräni, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2047-9980

Publisher:

American Heart Association

Language:

English

Submitter:

Pubmed Import

Date Deposited:

10 Oct 2022 14:29

Last Modified:

05 Dec 2022 16:26

Publisher DOI:

10.1161/JAHA.122.027098

PubMed ID:

36205254

Uncontrolled Keywords:

ACAOS L‐ACAOS PCI R‐ACAOS anomalous coronary artery originating from the opposite sinus of Valsalva coronary unroofing

BORIS DOI:

10.48350/173593

URI:

https://boris.unibe.ch/id/eprint/173593

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