Anomalous Aortic Origin of the Coronary Artery (AAOCA): Anomalous Right Coronary Artery from the Left Coronary Artery

Question 1

What does AAOCA stand for?

Answer 1

Anomalous aortic origin of a coronary artery

Question 2

What is AAOCA?

Answer 2

A congenital abnormality of the origin or course of a coronary artery that arises from the aorta

Question 3

How is normal coronary artery anatomy characterized?

Answer 3

By two ostia centrally placed in the right and left sinus of Valsalva

Question 4

From which ostium does the main left coronary artery (LCA) originate?

Answer 4

The left ostium

Question 5

What are the branches of the left coronary artery (LCA)?

Answer 5

• Left anterior descending artery
• Circumflex artery

Question 6

From which ostium does the right coronary artery (RCA) arise?

Answer 6

The right ostium

Question 7

What is the course of the right coronary artery (RCA)?

Answer 7

It provides an infundibular branch to the anterior side of the heart and then courses backward in the atrioventricular groove

Question 8

In AAOCA, where does the origin of one of the coronary arteries arise from?

Answer 8

The wrong sinus of Valsalva

Question 9

What is the second leading cause of sudden cardiac death in young athletes in the United States?

Answer 9

AAOCA

Question 10

What percentage of sudden cardiac death in young athletes is attributed to AAOCA?

Answer 10

17%

Question 11

What is the reported prevalence of anomalous right coronary artery (ARCA)?

Answer 11

0.06-0.9%

Question 12

What is the reported prevalence of anomalous left coronary artery (ALCA)?

Answer 12

0.025-0.15%

Question 13

What is the reported prevalence of anomalous circumflex coronary artery?

Answer 13

0.02-0.67%

Question 14

What is an anomalous left coronary artery?

Answer 14

An anomalous coronary artery originating from the aorta on the left side

This type of anomaly affects the left coronary artery specifically.

Question 15

What is an anomalous right coronary artery?

Answer 15

An anomalous coronary artery originating from the aorta on the right side

This type of anomaly affects the right coronary artery specifically.

Question 16

What is an anomalous circumflex coronary artery?

Answer 16

An anomalous coronary artery that arises from the aorta and follows a different course than normal

This refers to the circumflex artery being positioned abnormally.

Question 17

What is an anomalous left anterior descending coronary artery?

Answer 17

An anomalous coronary artery that originates from the aorta and follows an atypical path

This specifically involves the left anterior descending artery.

Question 18

What is a single coronary artery?

Answer 18

A condition where only one coronary artery supplies blood to the heart

This anomaly indicates a singular artery instead of the typical dual system.

Question 19

What are the types of anomalous courses for coronary arteries?

Answer 19

• Inter-arterial
• Intra-mural
• Intra-myocardial
• Retro-aortic
• Pre-pulmonic

These classifications describe the abnormal pathways that coronary arteries may take.

Question 20

What does inter-arterial mean in the context of coronary arteries?

Answer 20

The coronary artery travels between the aorta and the pulmonary artery

This describes a specific anomalous course of the coronary artery.

Question 21

What does intra-mural mean regarding coronary arteries?

Answer 21

The coronary artery travels within the aortic wall

This indicates that the artery is embedded in the wall of the aorta.

Question 22

What does intra-myocardial refer to in coronary artery anomalies?

Answer 22

The coronary artery travels into the myocardium instead of a normal epicardial course

This indicates an abnormal positioning within the heart muscle.

Question 23

What does retro-aortic mean?

Answer 23

The coronary artery travels behind the aorta

This describes a path that is not typical for coronary arteries.

Question 24

What does pre-pulmonic mean in the context of coronary arteries?

Answer 24

The coronary artery travels anterior to the pulmonary artery

This indicates that the artery is positioned in front of the pulmonary artery.

Question 25

How is ostial morphology of the anomalous coronary artery classified?

Answer 25

* Round: Antero-posterior diameter equals transverse diameter * Oval: Antero-posterior diameter is 50-90% of transverse diameter * Slit like: Antero-posterior diameter is <50 % of transverse diameter ## Footnote These classifications describe the shape and size of the artery at its origin.

Question 26

What limitations does echocardiography have in diagnosing anomalous coronary arteries?

Answer 26

Technical challenges limit its ability to accurately predict anomalous course and ostial morphology ## Footnote While echo can identify some anomalies, it is not always reliable for detailed analysis.

Question 27

What additional imaging modalities are useful for defining features of anomalous coronary arteries?

Answer 27

CT and MRI ## Footnote These imaging techniques provide more detailed information than echocardiography in cases of suspected anomalies.

Question 28

What is the most common presentation of patients with AAOCA?

Answer 28

Asymptomatic ## Footnote Sudden death can be the first manifestation in some patients.

Question 29

What is the consensus on the mechanisms of ischemia in AAOCA?

Answer 29

There is no clear consensus ## Footnote Mechanisms are still being studied and debated.

Question 30

What is presumed to cause myocardial ischemia in AAOCA during exercise?

Answer 30

Compression of anomalous coronary artery ## Footnote This can lead to ventricular fibrillation or tachycardia.

Question 31

List one proposed mechanism for coronary compressions in AAOCA.

Answer 31

* Compression of intra-mural segment by aortic expansion during exercise * Torsion, compression or kinking of inter-arterial coronary artery during exercise * Slit like ostia and flap like closure of the coronary artery during exercise * Vasospasm of coronary secondary to endothelial damage * Hypoplastic coronary artery that predisposes to insufficient blood flow and ischemia ## Footnote These mechanisms are proposed to explain ischemic events.

Question 32

Fill in the blank: Compression of _______ segment by aortic expansion occurs during exercise.

Answer 32

[intra-mural] ## Footnote This compression is one of the proposed mechanisms for ischemia.

Question 33

True or False: Torsion and kinking of the inter-arterial coronary artery can occur during exercise.

Answer 33

True ## Footnote This is one of the proposed mechanisms for coronary compression.

Question 34

What can lead to vasospasm of coronary arteries in AAOCA?

Answer 34

Endothelial damage ## Footnote This is one of the proposed mechanisms contributing to ischemia.

Question 35

What condition can predispose to insufficient blood flow and ischemia in patients with AAOCA?

Answer 35

Hypoplastic coronary artery ## Footnote This anatomical variation can affect blood flow.

Question 36

What is the primary goal of echocardiography?

Answer 36

To screen for coronary anomalies in children ## Footnote Echocardiography is an essential diagnostic tool in pediatric cardiology.

Question 37

What are important views in transthoracic echocardiogram?

Answer 37

* Parasternal short axis 2D and color Doppler * Parasternal long axis 2D and color Doppler * Modified high parasternal short and long axis views

Question 38

What does the parasternal short axis view help define?

Answer 38

The origin and proximal course of a coronary artery ## Footnote It distinguishes between single and two ostia and inter-arterial versus intra-mural segments.

Question 39

How can the inter-arterial/intra-mural course of anomalous left coronary artery be demonstrated?

Answer 39

By performing a subtle clockwise rotation of the transducer from the standard parasternal short-axis view.

Question 40

What technique is used to obtain the inter-arterial/intra-mural course of anomalous right coronary artery?

Answer 40

Moving the transducer medially and performing a subtle anti-clockwise rotation.

Question 41

What does the parasternal long axis view demonstrate?

Answer 41

The origin of the coronary artery in relation to the sinotubular junction and its proximal course.

Question 42

What are the benefits of using modified high parasternal short and long axis views?

Answer 42

Helpful to define the proximal course of the coronary artery.

Question 43

What is recommended to optimize high spatial and temporal resolution in echocardiography?

Answer 43

Use high-frequency probes and small sector width.

Question 44

What is the preferred duration for echocardiographic clips?

Answer 44

3-5 beats clip is preferred.

Question 45

What should be avoided during echocardiography recordings?

Answer 45

Still frames should be avoided.