Driesen Bart W, Warmerdam Evangeline G, Sieswerda Gert-Jan T, Schoof Paul H, Meijboom Folkert J, Haas Felix, Stella Pieter R, Kraaijeveld Adriaan O, Evens Fabiola C M, Doevendans Pieter A F M, Krings Gregor J, van Dijk Arie P J, Voskuil Michiel
Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, CX, 3584, The Netherlands.
Department of Cardiology, Radboudumc Nijmegen, Nijmegen, GA, 6525, The Netherlands.
Catheter Cardiovasc Interv. 2018 Jul;92(1):68-75. doi: 10.1002/ccd.27578. Epub 2018 Mar 9.
To describe the use of fractional flow reserve (FFR) and intravascular ultrasound (IVUS) in the evaluation of patients with anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS).
ACAOS of the right and left coronary are rare, but may lead to symptoms and impose a risk for sudden cardiac death, depending on several anatomical features. Assessment and risk estimation is challenging in (nonathlete) adults, especially if they present without symptoms or with atypical complaints.
The team retrospectively studied 30 consecutive patients with ACAOS with interarterial course, who received IVUS- and FFR-guided treatment at our institution between October 2010 and September 2017.
FFR was abnormal in only seven patients. IVUS showed the typical slit-like anatomy of the orifice in 23 patients. Based on FFR and/or IVUS results, in conjunction with the clinical presentation, clinical decision was made. A decision for intervention was made if at least two out of three entities were abnormal. Intervention implied unroofing of the coronary artery (n = 10) or coronary artery bypass grafting (n = 1). In all other patients a conservative strategy was followed. No adverse events occurred in the total population after a median of 37 (0-62) months of follow-up.
Conservative treatment may be justifiable in adult patients with ACAOS in the presence of normal FFR and nonsuspicious symptoms, despite the presence of an interarterial course and/or slitlike orifice on IVUS. We recommend the use of FFR and IVUS in the standard work-up for adult patients with ACAOS and propose the use of a flowchart to aid in decision-making.
描述血流储备分数（FFR）和血管内超声（IVUS）在评估起源于对侧瓦尔萨尔瓦窦的异常冠状动脉（ACAOS）患者中的应用。
左右冠状动脉的ACAOS很少见，但根据一些解剖特征，可能会导致症状并带来心脏性猝死风险。在（非运动员）成年人中进行评估和风险估计具有挑战性，尤其是当他们没有症状或有非典型症状时。
该团队回顾性研究了30例连续的具有动脉间走行的ACAOS患者，这些患者在2010年10月至2017年9月期间在我们机构接受了IVUS和FFR引导下的治疗。
仅7例患者的FFR异常。IVUS在23例患者中显示出典型的口部裂隙样解剖结构。根据FFR和/或IVUS结果，结合临床表现做出临床决策。如果三个指标中至少两个异常，则决定进行干预。干预包括冠状动脉开窗术（n = 10）或冠状动脉旁路移植术（n = 1）。在所有其他患者中，采取保守策略。在中位随访37（0 - 62）个月后，总体人群中未发生不良事件。
对于FFR正常且症状不可疑的成年ACAOS患者，尽管存在动脉间走行和/或IVUS显示裂隙样口部，保守治疗可能是合理的。我们建议在成年ACAOS患者的标准检查中使用FFR和IVUS，并建议使用流程图辅助决策。
