Capponi Guglielmo, Castaldi Biagio, Sirico Domenico, Reffo Elena, Assanta Nadia, Santoro Giuseppe, Prati Francesco, Pozza Alice, Cantinotti Massimiliano, Salvo Giovanni Di
Department of Pediatric Cardiology and Congenital Heart Disease, National Research Council-Tuscany Region G. Monasterio Foundation (FTGM), Massa, Pisa, Italy.
Pediatric Cardiology Unit, Department of Woman's and Child's Health, University-Hospital of Padova, University of Padua, Padua, Italy.
Echocardiography. 2025 Jun;42(6):e70213. doi: 10.1111/echo.70213.
Coronary artery anomalies represent a series of congenital heart diseases characterized by the abnormal circulation of coronary arteries. Of particular interest is the anomalous aortic origin of coronary arteries (AAOCA), an underdiagnosed but potentially fatal anomaly, specifically relevant in young adult athletes. During the last decades, knowledge of the pathophysiology of AAOCA-related ischemic mechanisms has increased, and major risk conditions have been discovered. Unfortunately, a universally shared approach is still lacking, and clinicians often follow the policy of their own centers. Most of the population with AAOCA is asymptomatic or complains of minor symptoms but is among them that there is much more uncertainty about the correct strategy to perform a risk stratification process, and consequently for providing indications on exercise restriction or surgery. This review focuses on the diagnostic approach to coronary anomalies and discusses the diagnostic workflow in these patients. Finally, we perform an in-depth analysis of novel angiographic invasive functional methods and how they contribute to AAOCA in selected cases.
冠状动脉异常是一系列以冠状动脉血液循环异常为特征的先天性心脏病。特别值得关注的是冠状动脉起源于主动脉异常（AAOCA），这是一种诊断不足但可能致命的异常情况，在年轻成年运动员中尤为相关。在过去几十年里，对AAOCA相关缺血机制的病理生理学认识有所增加，并且发现了主要的风险状况。不幸的是，目前仍缺乏一种普遍适用的方法，临床医生往往遵循各自中心的策略。大多数患有AAOCA的人无症状或仅有轻微症状，但在这些人中，对于进行风险分层过程的正确策略，以及因此对于提供运动限制或手术的指征，存在更多的不确定性。本综述重点关注冠状动脉异常的诊断方法，并讨论这些患者的诊断流程。最后，我们对新型血管造影侵入性功能方法及其在特定病例中对AAOCA的作用进行了深入分析。
