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Management of Adults With Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art ReviewGET ACCESS

JACC State-of-the-Art Review

J Am Coll Cardiol, 82 (21) 2034–2053
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Abstract

As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a systematic review and critical evaluation of the available evidence on the interventional treatment of AAOCA in adult patients. Using a structured Delphi process, the group agreed on expert recommendations that are intended to complement existing clinical practice guidelines.

Highlights

Expanded use of cardiac imaging has resulted in the identification of a greater number of adults with AAOCA, which encompasses a wide range of anomalies and associated symptoms.

This variability makes general recommendations difficult to apply, so using a structured Delphi process, an expert panel agreed on recommendations that complement clinical practice guidelines.

Individualized implementation requires understanding of the mechanisms of ischemia in patients with AAOCA, the approach to symptoms, the role of imaging, clinical risk assessment, and options for revascularization.

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