Abstract 2592: Clinical Events and MSCTA Anatomy in Anomalous Coronary Artery Arising from the Opposite Coronary Sinus (AOCOS): Relationship of the Pulmonary Valve, Slit-like Orifice, and Arterial Course
Background: Anomalous Orgin of a Coronary from the Opposite Sinus (AOCOS) is associated with myocardial infarction and sudden death. Proximal vessel variations and course can be difficult to assess by conventional angiography but can be easily imaged noninvasively by Multislice CT facilitating appropriate clinical management.
Methods: We evaluated proximal vessel variations by MSCT in patients with AOCOS including the presence of a slit-like orifice, interarterial course between the aorta and pulmonary artery, relationship to the pulmonic valve, and the presence of spontaneous cardiac events.
Results: 2500 cases were examined by MSCTA in pts referred for chest pain, abnormal stress testing, or acute coronary syndrome in a large volume clinical setting. There were 28 cases (1.1%) of AOCOS with 16/28 (58%) of RCA off the left cusp (2 single coronaries) and 12/28 (42%) of LCA off the right cusp (4 single coronaries). RCA off the left sinus: 14/16 with interarterial course, origin above the pulmonic valve with 2/16 interarterial but below the pulmonic valve. 9/16 had slit-like orifice, 2/16 highly angled ostium without slit-like orifice. 8/16 pts (50%) underwent CABG while 8/16 (50%) were treated medically. LCA off the right sinus: 1/12 (8%) was above the level of the pulmonic valve, none had a slit-like orifice. 5/12 (42%) had an intraseptal course below the pulmonic valve. Two pts underwent CABG. Spontaneous events: 3/28 (11%) pts initially presented with spontaneous clinical events (NSTEMI, sustained VT, acute inferior MI) attributed directly to the coronary anomaly. All three of these pts had a slit-like orifice, an origin at or above the level of the pulmonary valve, an interarterial course, and a RCA off the left sinus.
Anomalous coronary arteries arising from the opposite sinus can be readily characterized by MSCT.
MSCT can now be used to help select patients for revascularization with high risk characteristics
All patients who presented with a spontaneous malignant event had a slit-like orifice, an interarterial course, and an origin at or above the pulmonic valve.