We sought to prospectively evaluate evidence of myocardial ischemia following surgical repair of anomalous aortic origin of a coronary artery with an interarterial course (AAOCA).
AAOCA is a rare anomaly associated with increased myocardial ischemia and sudden death risk in children. Data evaluating ischemia after AAOCA repair are limited.
We included children who underwent AAOCA surgery between 10/01–12/06. They were prospectively assessed using exercise stress test (EST), stress echocardiogram (SE), and stress myocardial perfusion scan (MPS).
Of 24/26 eligible children, 15 (63%) were male, 16 (67%) had anomalous right coronary (ARCA), and 7 (29%) were asymptomatic. Median age was 12 (5–18) years; follow-up was 15 (2–48) months. All had unobstructed neo-coronary ostia by echocardiogram and were asymptomatic. One ALCA and 8 ARCA patients had post-operative evaluations suggestive of ischemia. The ALCA patient had reversible apical septal and mid-anteroseptal hypokinesis on SE. Of the ARCA patients, 2 had inferior ST depression on EST; subsequently, one had normal tests but the other developed anterolateral Q waves. Two had blunted blood pressure response with EST, one had fixed apical inferior hypokinesis on SE, two had reversible perfusion defects on MPS, and one had a fixed perfusion defect on MPS.
Subclinical changes suggestive of ischemia may occur despite patent neo-coronary ostia, notably after ARCA repair. The implication of these results on indication for surgery and subsequent sudden death risk is unknown. Serial EST, SE, and MPS are essential in evaluating ongoing ischemia risk after AAOCA repair.
Anomalous aortic origin of a coronary artery that courses between the great vessels (AAOCA) is a rare anomaly associated with increased myocardial ischemia and sudden death risk in children. We prospectively assessed children using exercise stress test, stress echocardiogram, and stress myocardial perfusion scan. One ALCA and 8 ARCA patients had positive ischemia evaluations. Subclinical changes suggestive of ischemia may occur despite patent neo-coronary ostia, notably after ARCA repair.
Keywords: coronary artery anomalies, pediatric cardiac surgery, ischemia