Anomalous coronary arteries (ACAs) may be clinically silent and totally benign or associated with catastrophic and fatal presentations. It has been postulated that the proximal course of an ACA is a decisive factor in risk stratification and surgical approach. Particularly, a course between the aorta and pulmonary trunk carries a high risk of major adverse events. We sought to evaluate the anatomic course of documented ACAs by transesophageal echocardiography (TEE) and to study their functional importance using stress–rest 99mTc-sestamibi (99mTc- MIBI) myocardial perfusion SPECT. Methods: From a cohort of patients undergoing coronary angiography in our department between January 1997 and April 2003, we selected 14 with ACAs but without CAD (9 men and 5 women; mean age, 50.7 ! 14.6 y). All patients underwent TEE and stress–rest 99mTc-MIBI myocardial perfusion SPECT. Results: TEE correctly identified the origin of all ACAs and revealed an anomalous course between the great vessels in 5 patients. At exercise myocardial perfusion SPECT, 4 of 14 patients demonstrated a reversible myocardial perfusion defect. All these patients had an anomalous course between the aorta and pulmonary artery. Conclusion: In this study, 4 of 5 (80%) anomalous courses between the aorta and pulmonary artery were associated with the finding of a reversible perfusion defect on stress–rest SPECT. An integrated evaluation of anatomic course and hemodynamic importance could be useful in the management of ACA.
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|Titolo:||Stress-rest myocardial perfusion SPECT for functional assessment of coronary arteries with anomalous origin or course|
|Data di pubblicazione:||2004|
|Appare nelle tipologie:||1.1 Articolo in rivista|