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Noninvasive Multimodality Imaging for the Assessment of Anomalous Coronary Artery

  • Structural Heart Disease (S Vakamudi, Section Editor)
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Abstract

Purpose of Review

Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary anomaly with the potential to cause myocardial ischemia and adverse cardiac events. The presence of AAOCA anatomy itself does not necessarily implicate a need for revascularization. Therefore, the purpose of this review is to assess how noninvasive comprehensive anatomic- and physiologic evaluation may guide patient management.

Recent Findings

The assessment of AAOCA includes an accurate description of the anomalous origin/vessel course including anatomical high-risk features such as a slit-like ostium, proximal narrowing, elliptic vessel shape, acute take-off angle, intramural course, and possible concomitant coronary atherosclerosis and hemodynamics. Various cardiac imaging modalities offer unique advantages and capabilities in visualizing these anatomical and functional aspects of AAOCA.

Summary

This review explored the role of noninvasive multimodality imaging in the characterization of AAOCA by highlighting the strengths, limitations, and potential applications of the current different cardiac imaging methods, with a focus on the pathophysiology of myocardial ischemia and stress testing protocols.

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Funding

Dr. Gräni has received funding support for this work from the Swiss National Foundation (Grant Number 200871: Noninvasive anatomical assessment for ruling out hemodynamically relevant coronary artery anomalies—A comparison of coronary-CT to invasive coronary angiography [NARCO]).

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Authors and Affiliations

  1. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Christoph Gräni & Marius R. Bigler

  2. Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Raymond Y. Kwong

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  1. Christoph Gräni
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  2. Marius R. Bigler
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Correspondence to Raymond Y. Kwong.

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Conflict of Interest

Dr. Kwong has received research support from Bristol Myers Squibb, Alnylam Pharmaceuticals, Epirium Bio, and Bayer AG, outside of the submitted work. Dr. Gräni received funding from Innosuisse, CAIM, and GAMBIT foundations, outside of the submitted work. The other authors report that they have no relationships relevant to the contents of this paper to disclose.

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Gräni, C., Bigler, M.R. & Kwong, R.Y. Noninvasive Multimodality Imaging for the Assessment of Anomalous Coronary Artery. Curr Cardiol Rep 25, 1233–1246 (2023). https://doi.org/10.1007/s11886-023-01948-w

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