aortic origin of a coronary artery (AAOCA) is the second leading cause
of sudden cardiac death in young athletes in the USA. Long-term outcome
data for these patients are lacking to date. There is insufficient
knowledge on the best approach to these patients and they are managed in
a nonuniform manner.
online survey of 15 questions regarding management of AAOCA was sent
out to 198 cardiac healthcare providers. The goal was to define gaps in
knowledge to justify a dedicated scientific forum for discussion of
AAOCA. Descriptive statistics were performed.
total of 91 providers (46%) completed the survey including pediatric
cardiology subspecialists (40%), general pediatric cardiologists (24%),
cardiovascular (CV) surgeons (22%), adult cardiologists (10%), nurse
practitioners (8%), cardiology fellows (3%) and CV anesthesiologist
(1%). Forty-eight percent had been practicing for over 15 years and 28%
were in their first 5 years of practice. Fifty-two percent of the
providers cared for adults and 93% cared for children/adolescents.
Eighty-eight percent were affiliated with an academic institution. All
but one provider practiced in the USA, 62% practiced in Texas. Half of
participants (50%) were very comfortable managing AAOCA patients and 36%
were somewhat comfortable. Providers utilized various imaging tests to
confirm the anatomy including computed tomography angiography 88%,
cardiac magnetic resonance imaging 70%, cardiac catheterization 60%,
echocardiogram 12%, IVUS 2% and myocardial perfusion scan 1%. The
majority felt comfortable in counseling the families and felt that
depending on the type of lesion these patients should get surgical
referral (85%) vs clinical follow up (67%) with exercise restriction
is heterogeneity in the way AAOCA patients are currently evaluated and
managed. A knowledge gap exists even with participants from academic
institutions. Long-term data with a defined approach to management of
these patients may help to improve outcomes and prevent unnecessary
exercise restriction or surgery.