Management of Adults with Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review (JACC November 2023-2)-Article: Management of Adults with Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review

Article: Management of Adults with Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review

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The number of adult patients diagnosed with anomalous aortic origin of the coronary arteries (AAOCA) has increased due to imaging screening. However, current guidelines have limited recommendations for AAOCA management. To address this, experts conducted a review of evidence and provided expert recommendations through a Delphi process. Key findings include prevalence, ischemia mechanisms, effects of AAOCA on noncoronary cardiac surgery, and imaging for risk stratification. Anatomical features, symptoms, age, and activity level are crucial in clinical decision-making. The recommendations can guide clinicians in managing AAOCA patients.<br /><br />AAOCA is a rare congenital heart defect where coronary arteries arise abnormally. This paper reviews AAOCA in adults, discussing clinical presentation, evaluation, and treatment options. Individualized management based on patient characteristics and preferences is emphasized, with shared decision-making and treatment at experienced centers. Surgical repair is preferred, with percutaneous interventions for nonsurgical candidates. Surgical techniques like unroofing, ostioplasty, and reimplantation are discussed. Addressing mechanisms of ischemia in surgical repair and long-term follow-up are important for evaluation. Limited evidence exists, calling for further research on AAOCA understanding and management.

Keywords

AAOCA

imaging screening

AAOCA management

ischemia mechanisms

noncoronary cardiac surgery

anatomical features

surgical repair

percutaneous interventions

congenital heart defect

long-term follow-up