Potential Role for FFRct in Guidance of Therapy of Malignant Right Coronary Anomalies: Proof of Concept.

PURPOSE
Anomalous right coronary artery arising from the left sinus of Valsalva and coursing between the aortic root and pulmonary trunk is seen in 0,2-0,5% of the population and is associated with increased risk of sudden cardiac death. The ACC/AHA 2008 guidelines for adults with congenital heart disease suggest surgical coronary revascularization for those patients with evidence of ischemia. FFRCT is a novel computational technique which shows very good correlation with FFR in the haemodynamic assessment of coronary arteries. We want to investigate the potential usefulness of FFRCT in evaluating ischemia in malignant right coronary artery anomalies.
METHOD AND MATERIALS
Retrospective, blinded FFRct analysis was carried out in 7 patients with CTA-reported malignant right coronary artery anomaly. Evaluation of the potential impact of clinical adoption of FFRct to guide surgical intervention was based on the ACC/AHA 2008 guidelines for adults with CHD.
RESULTS
FFRct analysis demonstrated ischemia in 1 of the seven cases with an FFRct-value of 0,73 in the distal RCA. This was a 45-year old female patient in excellent general condition who presented with a history of “exercise-induced chest pain”. CTA examination showed a typical high-take-off origin of the RCA from the left sinus of Valsalva. Surgical revascularization was performed with good result. The other 6 cases had no clinical symptoms, did not show a high take-off of the RCA and medical management had been set up. No major cardiac events upon today were reported for the 7 patients.
CONCLUSION
Utilization of FFRct analysis in the evaluation of patients with malignant right coronary anomalies is feasible and offers a one-stop-shop assessment of the anatomical and physiological aspects of this clinical entity. This technique could play an important role in clinical decision making and guidance of therapy (surgical revascularization or medical management) in patients with this congenital coronary anomaly.
CLINICAL RELEVANCE/APPLICATION
Utilization of FFRct analysis in the evaluation of patients with malignant right coronary anomalies is feasible and offers a one-stop-shop assessment of the anatomical and physiological aspects of this clinical entity, thereby potentially playing an important role in clinical decision making and guidance of therapy (surgical revascularization or medical management) in patients with this congenital coronary anomaly.