Journal of Cardiovascular Computed Tomography xxx (2015) 1e3
Contents lists available at ScienceDirect
Journal of Cardiovascular Computed Tomography journal homepage: www.JournalofCardiovascularCT.com
Case report
Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin Tetsuma Kawaji*, Hiroki Shiomi, Satoshi Shizuta, Takeshi Kimura Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine, Japan
a r t i c l e i n f o
a b s t r a c t
Article history: Received 28 August 2015 Received in revised form 19 October 2015 Accepted 3 November 2015 Available online xxx
Anomalous aortic origin of coronary artery (AAOCA) is rare but critical for the association with sudden cardiac death. In detecting the origin of AAOCA, coronary CT angiography is more accurate than invasive coronary angiography, but only with anatomical evaluation. A novel technology FFRCT, which is noninvasively computed by coronary CT image, can evaluate functional ischemia of coronary artery even without atherosclerotic plaque and has potential for innovation in AAOCA. © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Keywords: FFRCT CCTA AAOCA FFR
Case report A 47-year old woman without cardiovascular risk factors reported atypical angina. Coronary computed tomography (CT)
angiography revealed an anomalous aortic origin of the right coronary artery (RCA) from the left coronary ostium, with a course between the aorta and pulmonary artery (Fig. 1). Non-invasive CTbased fractional flow reserve (FFRCT) (HeartFlow, Redwood, Cali-
Figure 1. Coronary CT angiography images. Ao ¼ Aorta, PA ¼ pulmonary artery, RCA ¼ right coronary artery.
* Corresponding author. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan. Tel.: þ81 75 751 4255. E-mail address: [email protected] (T. Kawaji).
fornia) suggested significant ischemia (FFRCT ¼ 0.67, Fig. 2) Conventional invasive FFR during coronary angiography also showed significant ischemia (FFR ¼ 0.75), although intravascular ultrasound showed no atherosclerotic plaque in the RCA (Fig. 3, Supplementary Video 1, 2, and 3). On the other hand, stress-induced
http://dx.doi.org/10.1016/j.jcct.2015.11.001 1934-5925/© 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Kawaji T, et al., Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.11.001
2
T. Kawaji et al. / Journal of Cardiovascular Computed Tomography xxx (2015) 1e3
Figure 2. FFRCT images.
Figure 3. Angiographic images. FFR ¼ fractional flow reserve, IVUS ¼ intra-vascular ultrasound, LAO ¼ left anterior oblique, RAO ¼ right anterior oblique.
ischemia was not detected in exercise stress perfusion singlephoton emission CT (SPECT) with tetrofosmin (Fig. 4). Treating physicians decided not to perform surgical repair given the absence of typical angina. The patient was free from cardiac events during after 1 year. While this is the first report of FFRCT in comparison to invasive FFR in an anomalous coronary artery, the discrepancy to
noninvasive ischemia testing suggests that clinical implications may be different than in atherosclerotic coronary artery disease [1], further systematic evaluation is required. Supplementary data related to this article can be found online at http://dx.doi.org/10.1016/j.jcct.2015.11.001.
Please cite this article in press as: Kawaji T, et al., Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.11.001
T. Kawaji et al. / Journal of Cardiovascular Computed Tomography xxx (2015) 1e3
3
Figure 4. Exercise stress perfusion single-photon emission CT images.
Disclosures None. Reference
Bruyne B, Bezerra H, Osawa K, Marwan M, Naber C, Erglis A, Park SJ, Christiansen EH, Kaltoft A, Lassen JF, Botker HE, Achenbach S, Group NXTTS. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63:1145e1155.
1. Norgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, Jensen JM, Mauri L, De
Please cite this article in press as: Kawaji T, et al., Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.11.001
Contents lists available at ScienceDirect
Journal of Cardiovascular Computed Tomography journal homepage: www.JournalofCardiovascularCT.com
Case report
Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin Tetsuma Kawaji*, Hiroki Shiomi, Satoshi Shizuta, Takeshi Kimura Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine, Japan
a r t i c l e i n f o
a b s t r a c t
Article history: Received 28 August 2015 Received in revised form 19 October 2015 Accepted 3 November 2015 Available online xxx
Anomalous aortic origin of coronary artery (AAOCA) is rare but critical for the association with sudden cardiac death. In detecting the origin of AAOCA, coronary CT angiography is more accurate than invasive coronary angiography, but only with anatomical evaluation. A novel technology FFRCT, which is noninvasively computed by coronary CT image, can evaluate functional ischemia of coronary artery even without atherosclerotic plaque and has potential for innovation in AAOCA. © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Keywords: FFRCT CCTA AAOCA FFR
Case report A 47-year old woman without cardiovascular risk factors reported atypical angina. Coronary computed tomography (CT)
angiography revealed an anomalous aortic origin of the right coronary artery (RCA) from the left coronary ostium, with a course between the aorta and pulmonary artery (Fig. 1). Non-invasive CTbased fractional flow reserve (FFRCT) (HeartFlow, Redwood, Cali-
Figure 1. Coronary CT angiography images. Ao ¼ Aorta, PA ¼ pulmonary artery, RCA ¼ right coronary artery.
* Corresponding author. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507 Japan. Tel.: þ81 75 751 4255. E-mail address: [email protected] (T. Kawaji).
fornia) suggested significant ischemia (FFRCT ¼ 0.67, Fig. 2) Conventional invasive FFR during coronary angiography also showed significant ischemia (FFR ¼ 0.75), although intravascular ultrasound showed no atherosclerotic plaque in the RCA (Fig. 3, Supplementary Video 1, 2, and 3). On the other hand, stress-induced
http://dx.doi.org/10.1016/j.jcct.2015.11.001 1934-5925/© 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Kawaji T, et al., Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.11.001
2
T. Kawaji et al. / Journal of Cardiovascular Computed Tomography xxx (2015) 1e3
Figure 2. FFRCT images.
Figure 3. Angiographic images. FFR ¼ fractional flow reserve, IVUS ¼ intra-vascular ultrasound, LAO ¼ left anterior oblique, RAO ¼ right anterior oblique.
ischemia was not detected in exercise stress perfusion singlephoton emission CT (SPECT) with tetrofosmin (Fig. 4). Treating physicians decided not to perform surgical repair given the absence of typical angina. The patient was free from cardiac events during after 1 year. While this is the first report of FFRCT in comparison to invasive FFR in an anomalous coronary artery, the discrepancy to
noninvasive ischemia testing suggests that clinical implications may be different than in atherosclerotic coronary artery disease [1], further systematic evaluation is required. Supplementary data related to this article can be found online at http://dx.doi.org/10.1016/j.jcct.2015.11.001.
Please cite this article in press as: Kawaji T, et al., Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.11.001
T. Kawaji et al. / Journal of Cardiovascular Computed Tomography xxx (2015) 1e3
3
Figure 4. Exercise stress perfusion single-photon emission CT images.
Disclosures None. Reference
Bruyne B, Bezerra H, Osawa K, Marwan M, Naber C, Erglis A, Park SJ, Christiansen EH, Kaltoft A, Lassen JF, Botker HE, Achenbach S, Group NXTTS. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63:1145e1155.
1. Norgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, Jensen JM, Mauri L, De
Please cite this article in press as: Kawaji T, et al., Diagnosis of functional ischemia in a right coronary artery with anomalous aortic origin, Journal of Cardiovascular Computed Tomography (2015), http://dx.doi.org/10.1016/j.jcct.2015.11.001
