Congenital Heart Disease

1348484 - Assessing Myocardial Ischemia After Repair of AAOCA: Medium to Long Term Outcomes

Thursday, January 26, 2023

1:00 PM – 2:00 PM

Location: Pacific Jewel

Presenting Author(s)

Shagun Sachdeva, MD FASE

Assistant Professor
Baylor College of Medicine
Bellaire, Texas, United States

Primary Author(s)

Shagun Sachdeva, MD FASE

Assistant Professor
Baylor College of Medicine
Bellaire, Texas, United States

Co-Author(s)

TD

Tam T. Doan, MD, MSc

Pediatric Cardiologist
Texas Children's Hospital, United States
DR

Dana Reaves O'Neal

APP
Texas Children's Hospital, United States
Prakash M. Masand, MD

Associate Professor
Baylor College of Medicine
Houston, Texas, United States
ZB

Ziyad Binsalamah, MD

Assistant Professor
Baylor College of Medicine, United States
SM

Silvana Molossi, MD, PhD

Associate Professor
Baylor College of Medicine
Houston, Texas, United States

Background: Anomalous aortic origin of a coronary artery (AAOCA) is one of the leading causes of myocardial ischemia and sudden death in the young. Several surgical techniques have been utilized to alter the natural course in the presumed high-risk cases. We present medium to long term outcomes in AAOCA patients following surgical repair.

Methods: Patients who presented to the Coronary Artery Anomalies Program at Texas Children’s were evaluated and managed following a standardized approach, including computed tomography angiography for anatomy, functional testing with cardiopulmonary exercise stress test (CPET) and stress perfusion imaging with dobutamine stress cardiac magnetic resonance imaging (DSCMR) and/or stress nuclear perfusion (sNP). Surgical intervention was indicated in high-risk patients according to anatomic features, symptoms and inducible ischemia on functional testing under provocative stress. Re-evaluation was undertaken at 3 months post-op and again at 3-5 years after surgical repair.

Results: A total of 23 AAOCA patients were included (61% males), 5 (22%) AAOLCA, 18 (78%) AAORCA, 2 with myocardial bridge (MB); and 3 (13%) presented with exertional symptoms. Only 1 (4.3%) had a positive CPET. Preoperatively, 5 (22%) had a DSCMR, 17 (74%) had sNP; of which 2/23 (8.6%) had positive study for inducible ischemia. Surgical repair included coronary unroofing in 17 (74%), coronary reimplantation in 5 (22%), MB unroofing in addition in 1 (4.3%) and coronary ostioplasty in 1(4.3%). At a median duration of 3 [IQR 2-4] months postoperatively, 22/23 (95%) had repeat perfusion study: 8 (35%) had DSCMR, 14 (61%) had sNP; all of which were negative for ischemia. None of the patients had exertional symptoms or ischemic concerns on CPET in the medium to long term follow up. All patients underwent DSCMR at a median duration of 54 [IQR 42-66] months (4.5 years) post repair without evidence of fixed or inducible myocardial ischemia.

Conclusion: This study demonstrates excellent medium to long term outcomes in patients with AAOCA undergoing surgical repair with no evidence of exertional symptoms, fixed or inducible ischemia on myocardial functional studies under provocative stress.