Anomalous Coronary Arteries and Myocardial Bridges

Risk Stratification in Children Using Novel Cardiac Catheterization Techniques

Hitesh Agrawal, Silvana Molossi, Mahboob Alam, S. Kristen Sexson-Tejtel, Carlos M. Mery, E. Dean McKenzie, Charles D. Fraser, Athar M. Qureshi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children’s Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12–4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6–18.7) years and median weight 49.5 (11.4–142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.

Original languageEnglish (US)
Pages (from-to)624-630
Number of pages7
JournalPediatric Cardiology
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Fingerprint

Cardiac Catheterization
Coronary Vessels
Angiography
Dobutamine
Catheterization
Adenosine
Signs and Symptoms
Sports

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Anomalous Coronary Arteries and Myocardial Bridges : Risk Stratification in Children Using Novel Cardiac Catheterization Techniques. / Agrawal, Hitesh; Molossi, Silvana; Alam, Mahboob; Sexson-Tejtel, S. Kristen; Mery, Carlos M.; McKenzie, E. Dean; Fraser, Charles D.; Qureshi, Athar M.

In: Pediatric Cardiology, Vol. 38, No. 3, 01.03.2017, p. 624-630.

Research output: Contribution to journalArticle

Agrawal, Hitesh ; Molossi, Silvana ; Alam, Mahboob ; Sexson-Tejtel, S. Kristen ; Mery, Carlos M. ; McKenzie, E. Dean ; Fraser, Charles D. ; Qureshi, Athar M. / Anomalous Coronary Arteries and Myocardial Bridges : Risk Stratification in Children Using Novel Cardiac Catheterization Techniques. In: Pediatric Cardiology. 2017 ; Vol. 38, No. 3. pp. 624-630.
@article{5ddb269f5b1b4667b702f83a5a52c465,
title = "Anomalous Coronary Arteries and Myocardial Bridges: Risk Stratification in Children Using Novel Cardiac Catheterization Techniques",
abstract = "The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children’s Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12–4/16, 8 (6{\%}) patients underwent 9 cath investigations at median age 13.1 (2.6–18.7) years and median weight 49.5 (11.4–142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70{\%} intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.",
author = "Hitesh Agrawal and Silvana Molossi and Mahboob Alam and Sexson-Tejtel, {S. Kristen} and Mery, {Carlos M.} and McKenzie, {E. Dean} and Fraser, {Charles D.} and Qureshi, {Athar M.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1007/s00246-016-1559-4",
language = "English (US)",
volume = "38",
pages = "624--630",
journal = "Pediatric Cardiology",
issn = "0172-0643",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Anomalous Coronary Arteries and Myocardial Bridges

T2 - Risk Stratification in Children Using Novel Cardiac Catheterization Techniques

AU - Agrawal, Hitesh

AU - Molossi, Silvana

AU - Alam, Mahboob

AU - Sexson-Tejtel, S. Kristen

AU - Mery, Carlos M.

AU - McKenzie, E. Dean

AU - Fraser, Charles D.

AU - Qureshi, Athar M.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children’s Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12–4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6–18.7) years and median weight 49.5 (11.4–142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.

AB - The evaluation of the vast majority of children with anomalous aortic origin of a coronary artery (AAOCA) and/or myocardial bridges is performed with non-invasive testing. However, a subset of these patients may benefit from invasive testing for risk stratification. All patients included in the Coronary Anomalies Program (CAP) at Texas Children’s Hospital who underwent cardiac catheterization were included. Techniques included selective coronary angiograms (SCA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) measurements with provocative testing using adenosine and/or dobutamine infusions. Out of the 131 patients followed by the CAP between 12/12–4/16, 8 (6%) patients underwent 9 cath investigations at median age 13.1 (2.6–18.7) years and median weight 49.5 (11.4–142.7) kg. Six patients presented with cardiac signs/symptoms. Four patients had myocardial bridges of the left anterior descending (LAD) coronary artery, 2 patients had isolated AAOCA, and 2 patients had an anomalous left coronary artery (LCA) with an intramyocardial course of the LAD. SCA was performed in all patients. FFR was positive in 4/6 patients: IVUS showed >70% intraluminal narrowing in 3/5 patients. One patient had hemodynamic instability that reversed with catheter removal from the coronary ostium. Based on the catheterization data obtained, findings were reassuring in three patients, surgery was performed in three patients, and two patients are being medically managed/restricted from competitive sports. In our small cohort of patients, we demonstrated that IVUS and FFR can safely be performed in children and may help to risk stratify some patients with AAOCA and myocardial bridges.

UR - http://www.scopus.com/inward/record.url?scp=85013031897&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85013031897&partnerID=8YFLogxK

U2 - 10.1007/s00246-016-1559-4

DO - 10.1007/s00246-016-1559-4

M3 - Article

VL - 38

SP - 624

EP - 630

JO - Pediatric Cardiology

JF - Pediatric Cardiology

SN - 0172-0643

IS - 3

ER -