Matthew A. Harris, MD, Kevin K. Whitehead, MD, PhD, David C

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Presentation transcript:

Identifying Abnormal Ostial Morphology in Anomalous Aortic Origin of a Coronary Artery Matthew A. Harris, MD, Kevin K. Whitehead, MD, PhD, David C. Shin, MD, Marc S. Keller, MD, Paul M. Weinberg, MD, Mark A. Fogel, MD The Annals of Thoracic Surgery Volume 100, Issue 1, Pages 174-179 (July 2015) DOI: 10.1016/j.athoracsur.2015.02.031 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Two-dimensional off-axis transverse image profiling the coronary origins in a patient with anomalous right coronary artery (RCA). Note that it is unclear whether the origins of the RCA and left coronary artery (LCA) are distinct from the left sinus of Valsalva or if there is a common ostium. (Ao = aorta; PA = pulmonary artery.) (B) Example of the virtual angioscopy postprocessing technique. Note the data of the above patient have been loaded into a multiplanar reformatting program, allowing for observation of the three-dimensional dataset from sagittal (top left), transverse (bottom left), and coronal (top right) perspectives. Upon activating the virtual angioscopy program (bottom right), the user can directly view the coronary ostia from the aorta. The Annals of Thoracic Surgery 2015 100, 174-179DOI: (10.1016/j.athoracsur.2015.02.031) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Virtual angioscopy–generated image of the patient in Figure 1 with anomalous right coronary artery (RCA). The black lines represent vertical and horizontal measurements of the coronary ostia. The ratio of the vertical-to-horizontal measurement was used to determine the degree of ellipticity of the anomalous coronary ostium relative to the normal coronary. (LCA = left coronary artery.) The Annals of Thoracic Surgery 2015 100, 174-179DOI: (10.1016/j.athoracsur.2015.02.031) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Virtual angioscopy image obtained from the perspective of the ascending aorta looking downward toward the aortic sinuses. Note the anomalous right coronary artery (RCA) and normal left coronary artery (LCA) origins in the region of the left sinus. The location of each ostium was described by the ratio of the angle between each ostium and the intercoronary commissure and the angle between the intercoronary commissure and its neighboring noncoronary commissure. (The image is for demonstration purposes and is not from a patient in our dataset.) The Annals of Thoracic Surgery 2015 100, 174-179DOI: (10.1016/j.athoracsur.2015.02.031) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (Left) Intraoperative photograph of a patient with anomalous origin of the left coronary artery. Note the elliptical shape of the left coronary artery (LCA) origin compared with the round shape of the right coronary artery (RCA) origin. (Right) Virtual angioscopy image acquired preoperatively reflects the findings at surgery. (AAO = ascending aorta.) The Annals of Thoracic Surgery 2015 100, 174-179DOI: (10.1016/j.athoracsur.2015.02.031) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Heart of a 12-year-old girl who collapsed after exercise. At autopsy, extensive hemorrhagic myocardial infarction is evident (white arrowheads). (B) Two-dimensional postmortem magnetic resonance image from a three-dimensional dataset of the aortic sinuses and proximal coronaries. This patient had anomalous origin of the left coronary artery (LCA) with a retroaortic left coronary artery course and, consequently, without an interarterial course. (C) The coronary dataset was analyzed with virtual angioscopy (right), which correlates with the specimen photograph (left). (RCA = right coronary artery.) The Annals of Thoracic Surgery 2015 100, 174-179DOI: (10.1016/j.athoracsur.2015.02.031) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions