Undergraduate Research Scholars Program, University of Wisconsin, Madison, WI, USA.
Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Pediatr Cardiol. 2024 Oct;45(7):1542-1549. doi: 10.1007/s00246-023-03206-w. Epub 2023 Jun 30.
The management of patients with an anomalous aortic origin of a coronary artery (AAOCA) remains controversial despite the publication of the 2017 American Association for Thoracic Surgery (AATS) expert guidelines. We surveyed the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and the Pediheart.net online community regarding their care of patients with anomalous origins of the right or left coronary from the opposite cusp with inter-arterial courses and compared them to the AATS guidelines. We received 111 complete responses. Four notable variations from the AATS recommendations were identified. Respondents were more likely to use ECG exercise testing than the stress imaging recommended in the AATS guidelines. For a 16-year-old with AAOCA, recommendations for surgery generally followed the AATS guidelines. However, for asymptomatic left AAOCA without signs of ischemia on stress imaging, only 69.4% felt surgery was appropriate or somewhat appropriate. In the setting of a 16-year-old with right AAOCA free from signs or symptoms of ischemia, respondents were more likely to recommend surgery if the patient was a competitive athlete, a topic not directly addressed in the AATS guidelines. After surgical treatment of AAOCA, only 24% of respondents recommended lifelong antiplatelet therapy despite recommendations for this in the AATS guidelines. Respondents recommendations were generally consistent with the 2017 AATS guidelines but with important variations in the use of stress imaging, indications for surgery in asymptomatic left AAOCA, the impact of identification as a competitive athlete and duration of postoperative antiplatelet therapy.
尽管 2017 年美国胸外科学会 (AATS) 专家指南已经发布，但对于冠状动脉异常起源 (AAOCA) 患者的管理仍然存在争议。我们调查了美国儿科学会心脏病学和心脏外科学科以及 Pediheart.net 在线社区，了解他们对具有动脉间行程的右或左冠状动脉异常起源的患者的治疗方法，并将其与 AATS 指南进行了比较。我们收到了 111 份完整的回复。我们发现了四个与 AATS 建议明显不同的地方。与 AATS 指南推荐的应激成像相比，受访者更倾向于使用心电图运动试验。对于 16 岁的 AAOCA 患者，手术建议通常遵循 AATS 指南。然而，对于无症状的左 AAOCA 且应激成像无缺血迹象，只有 69.4%的人认为手术是合适或有些合适的。对于无症状无缺血迹象的右 AAOCA 患者，如果患者是竞技运动员，那么只有 69.4%的受访者更倾向于建议手术，而这在 AATS 指南中并没有直接涉及。尽管 AATS 指南建议术后使用抗血小板治疗，但只有 24%的受访者建议终身使用抗血小板治疗。尽管与 AATS 指南建议一致，但在应激成像的使用、无症状左 AAOCA 手术的指征、确定为竞技运动员的影响以及术后抗血小板治疗的持续时间等方面存在重要差异。
