Abstract
Background
The variation and accuracy of computed tomography angiography (CTA) features of anomalous
aortic origin of a coronary artery (AAOCA) have not been completely characterized.
We evaluated anomalous right (AAORCA) and left (AAOLCA) coronary arteries by CTA,
with an emphasis on reproducibility, comparison with surgical measurements, and effect
of nitroglycerin.
Methods
CTAs were interpreted for location of coronary origin & exit from the aorta, course,
and dominance; minor & major diameters of the proximal & distal coronaries; shape
of orifice; and intramural length. Relationships between vessel measurements, body
surface area (BSA), and nitroglycerin use were evaluated. Comparisons between CTA
and surgical measurements included intramural length, surgical probe size pre-intervention
vs. CTA proximal AAOCA diameter, and surgical probe size post-intervention vs. CTA
distal AAOCA diameter.
Results
Of 104 patients [81 (78%) AAORCA], all but 1 were intramural. Compared to AAOLCA,
AAORCA patients were more likely to have a high origin (91% vs. 31%, p < 0.01),
and slit-like orifice (58% vs. 26%, p < 0.01). When CTAs with nitroglycerin were
compared to those without, no difference in proximal AAOCA dimensions was identified;
however distal AAOCA and normal-origin coronary dimensions were larger in scans with
nitroglycerin. Aside from slit-like orifice, reliability of coronary CTA measurements,
including proximal AAOCA minor diameter and intramural length, was moderate to good
between readers. In a subgroup of 54 patients, proximal AAOCA minor diameter and intramural
length had good agreement and correlation with surgery.
Conclusion
Proximal AAOCA dimensions and intramural length are reproducible variables. The lack
of difference in proximal AAOCA dimensions with nitroglycerin may reflect abnormal
vessel mechanics. Multicenter studies are an important next step in understanding
the generalizability of our findings.
Keywords
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Article info
Publication history
Published online: February 16, 2023
Accepted:
February 6,
2023
Received in revised form:
February 3,
2023
Received:
December 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
