Bicuspid Aortic Valve and Coronary Anomalies
2003; Lippincott Williams & Wilkins; Volume: 107; Issue: 16 Linguagem: Inglês
10.1161/01.cir.0000067687.37985.c4
ISSN1524-4539
AutoresRoberto Barriales‐Villa, Manuel Penas-Lado, César Morı́s,
Tópico(s)Congenital Heart Disease Studies
ResumoHomeCirculationVol. 107, No. 16Bicuspid Aortic Valve and Coronary Anomalies Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBBicuspid Aortic Valve and Coronary Anomalies Roberto Barriales-Villa, MD, FESC and Manuel Penas-Lado, MD César Morís, MD, FESC Roberto Barriales-VillaRoberto Barriales-Villa Cardiology Service, Complexo Hospitalario de Pontevedra, Pontevedra, Spain, and Manuel Penas-LadoManuel Penas-Lado Cardiology Service, Complexo Hospitalario de Pontevedra, Pontevedra, Spain, César MorísCésar Morís Cardiology Service, Hospital Central de Asturias, Oviedo, Spain Originally published29 Apr 2003https://doi.org/10.1161/01.CIR.0000067687.37985.C4Circulation. 2003;107:e105To the Editor:We congratulate Dr Fedak et al1 on their excellent review of bicuspid aortic valve. As the authors mention, a clear relation, possibly genetic, seems to exist between a bicuspid aortic valve and coronary artery anomalies.1 Anomalous origins of the right2 and left3 coronary arteries have been noted in patients with bicuspid aortic valves. Because many of these patients will require aortic valve replacement, we believe that coronary angiography (or another imaging technique, such as magnetic angioresonance4 or an electron beam computed tomography5) is essential in these patients before surgery, independent of their age and clinical suspicion of associated coronary atherosclerotic disease. The identification of a coronary anomaly would avoid possible injury to the anomalous artery during surgical repair. References 1 Fedak PWM, Verma S, David TE, et al. Clinical and pathophysiological implications of a bicuspid aortic valve. Circulation. 2002; 106: 900–904.LinkGoogle Scholar2 Palomo AR, Schrager BR, Chahine RA. Anomalous origin of the right coronary artery from the ascending aorta high above the left posterior sinus of Valsalva of a bicuspid aortic valve. Am Heart J. 1985; 109: 902–904.CrossrefMedlineGoogle Scholar3 Doty DB. Anomalous origin of the left circumflex coronary artery associated with bicuspid aortic valve. J Thorac Cardiovasc Surg. 2001; 122: 842–843.CrossrefMedlineGoogle Scholar4 McConnell MV, Ganz P, Selwyn AP, et al. Identification of anomalous coronary arteries and their anatomic course by magnetic resonance coronary angiography. Circulation. 1995; 92: 3158–3162.CrossrefMedlineGoogle Scholar5 Rensing BJ, Bongaerts A, van Geuns RJ, et al. Intravenous coronary angiography by electron beam computed tomography: a clinical evaluation. Circulation. 1998; 98: 2509–2512.CrossrefMedlineGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseFedak Paul W.M., , MD, Verma Subodh, , MD, PhD, David Tirone E., , MD, Weisel Richard D., , MD, Leask Richard L., , PhD, and Butany Jagdish, , MD29042003Coronary anomalies are rare congenital cardiac malformations that occur in less than 1% of the population. When present, these malformations are usually an ectopic origin of the right or left coronary artery from the aorta. In rare circumstances, coronary anomalies can result in myocardial malperfusion with devastating clinical consequences. However, the vast majority of coronary anomalies are benign, and accordingly, they are often identified only as incidental findings during diagnostic testing for other reasons. When coronary anomalies are suspected, they can be identified by a number of different imaging modalities, as indicated by Barriales-Villa and colleagues. Although coronary angiography remains the gold standard, a noninvasive approach with coronary magnetic resonance angiography may replace conventional methods in the future.1Patients with bicuspid aortic valve disease may have a coexisting coronary anomaly. When undergoing valve repair or replacement, there is a potential risk of coronary injury during surgery. The preoperative determination of the presence and location of an anomalous coronary artery, in theory, may reduce the risk of injury at the time of surgery. However, in contrast to Barriales-Villa and colleagues, we do not believe that the routine use of coronary angiography is indicated in all patients with bicuspid aortic valve disease before surgery. Echocardiography is a readily available, practical, and noninvasive imaging modality that is performed in all patients with valve disease before surgery. Echocardiography is capable of detecting coronary anomalies if suspected at the time of study, and in fact, is sometimes capable of detecting anomalies missed by conventional angiography.2,3Preoperative tests, even if indicated, can give incorrect results. There is no substitute for a careful and comprehensive inspection of the aorta at the time of surgery to avoid injury to an anomalous coronary artery. Echocardiography is routinely performed in these patients before surgery, and additional tests to search for coronary anomalies may not be necessary. Despite a few infrequent reports in the literature of injury to an anomalous coronary artery during valve replacement, in our surgical series of bicuspid valve patients,4 we did not make any extra efforts to identify coronary anomalies before surgery, and we have successfully avoided this complication. In patients with bicuspid aortic valve disease, we believe that preoperative testing should be considered on a case-by-case basis in coordination with the surgeon performing the procedure. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Cho S, Jeon K and Bae K (2015) Anomalous origin and aneurysm of the right coronary artery associated with congenital bicuspid aortic valve: MDCT findings, SpringerPlus, 10.1186/s40064-015-1214-1, 4:1, Online publication date: 1-Dec-2015. Srichai M and Mason D (2014) Coronary Artery Anomalies Cardiac CT and MR for Adult Congenital Heart Disease, 10.1007/978-1-4614-8875-0_27, (603-634), . Lowry A, Olabiyi O, Adachi I, Moodie D and Knudson J (2013) Coronary Artery Anatomy in Congenital Heart Disease, Congenital Heart Disease, 10.1111/chd.12067, 8:3, (187-202), Online publication date: 1-May-2013. Unzué-Vallejo L, Andreu-Dussac J, Sánchez-Sánchez V and Gragera-Torres F (2012) Anomalía coronaria congénita familiar, Revista Española de Cardiología, 10.1016/j.recesp.2012.01.023, 65:9, (859-861), Online publication date: 1-Sep-2012. Unzué-Vallejo L, Andreu-Dussac J, Sánchez-Sánchez V and Gragera-Torres F (2012) Congenital Hereditary Anomalous Coronary Artery Origin, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2012.01.025, 65:9, (859-861), Online publication date: 1-Sep-2012. Barriales-Villa R, Morís C, Sanmartín J, Fernández E, Pajín F and Ruiz Nodar J (2006) Anomalous Coronary Arteries Originating in the Contralateral Sinus of Valsalva: Registry of Thirteen Spanish Hospitals (RACES), Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(07)60013-9, 59:6, (620-623), Online publication date: 1-Jun-2006. Barriales-Villa R and Morís de la Tassa C (2006) Congenital Coronary Artery Anomalies With Origin in the Contralateral Sinus of Valsalva: Which Approach Should We Take?, Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(06)60773-1, 59:4, (360-370), Online publication date: 1-Apr-2006. Barriales-Villa R and de la Tassa C (2006) Anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral: ¿qué actitud se debe seguir?, Revista Española de Cardiología, 10.1157/13087058, 59:4, (360-370), Online publication date: 1-Apr-2006. Barriales-Villa R, Morís C, Sanmartín J, Fernández E, Pajín F and Ruiz Nodar J (2006) Registro de anomalías congénitas de las arterias coronarias con origen en el seno de Valsalva contralateral en 13 hospitales españoles (RACES), Revista Española de Cardiología, 10.1157/13089750, 59:6, (620-623), Online publication date: 1-Jun-2006. Fedak P, David T, Borger M, Verma S, Butany J and Weisel R (2014) Bicuspid aortic valve disease: recent insights in pathophysiology and treatment, Expert Review of Cardiovascular Therapy, 10.1586/14779072.3.2.295, 3:2, (295-308), Online publication date: 1-Mar-2005. April 29, 2003Vol 107, Issue 16 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000067687.37985.C4PMID: 12719292 Originally publishedApril 29, 2003 PDF download Advertisement
Referência(s)