AAOCA (Anomalous Aortic Origin of Coronary Artery) Flashcards¶
Classification¶
Q: What is AAOCA? A: Anomalous Aortic Origin of Coronary Artery - coronary arises from wrong aortic sinus Tags: aaoca, definition
Q: What does AAOLCA mean? A: Anomalous Aortic Origin of LEFT Coronary Artery (left from right sinus) - HIGH RISK Tags: aaoca, aaolca, high-yield
Q: What does AAORCA mean? A: Anomalous Aortic Origin of RIGHT Coronary Artery (right from left sinus) - LOWER risk Tags: aaoca, aaorca
Q: What is the relative risk of SCD: AAOLCA vs AAORCA? A: AAOLCA = HIGH risk (surgery recommended); AAORCA = LOWER but not zero risk Tags: aaoca, risk, high-yield
Q: AAOCA is what rank among causes of SCD in young athletes? A: Second most common cause of SCD in young athletes Tags: aaoca, scd, high-yield
High-Risk Anatomic Features¶
Q: What is an interarterial course? A: Coronary passes BETWEEN aorta and pulmonary artery - high risk feature Tags: aaoca, anatomy, high-yield
Q: What is an intramural course? A: Coronary runs WITHIN the aortic wall - high risk feature Tags: aaoca, anatomy, high-yield
Q: What other anatomic features increase AAOCA risk? A: Slit-like ostium (restricted flow), acute take-off angle (kinking), proximal compression Tags: aaoca, anatomy
Q: What is the mechanism of ischemia in interarterial AAOCA? A: During exercise, aorta and PA expand and compress the interarterial coronary Tags: aaoca, mechanism
Diagnostic Evaluation¶
Q: What is the gold standard imaging for AAOCA anatomy? A: CT angiography Tags: aaoca, imaging, high-yield
Q: What does CT angiography assess in AAOCA? A: Course (interarterial vs other), ostium shape, intramural segment, relationship to great vessels Tags: aaoca, cta
Q: What is the role of echocardiography in AAOCA? A: Initial screening (limited sensitivity); may miss anomalies Tags: aaoca, echo
Q: What functional testing is preferred for AAOCA risk stratification? A: Exercise stress CMR (or stress nuclear, exercise stress echo) Tags: aaoca, stress-testing, high-yield
Q: When is catheterization with IVUS indicated in AAOCA? A: For surgical planning - assesses intramural segment and ostial morphology Tags: aaoca, ivus
Management¶
Q: What is the management for AAOLCA with interarterial course? A: Surgery recommended REGARDLESS of symptoms Tags: aaoca, aaolca, management, high-yield
Q: What is the management for AAORCA with interarterial course, symptomatic? A: Surgery recommended Tags: aaoca, aaorca, management
Q: What is the management for AAORCA with interarterial course, asymptomatic, negative stress test? A: Observation OR surgery (shared decision-making) Tags: aaoca, aaorca, management, high-yield
Q: What if stress test is positive in AAORCA? A: Surgery recommended (demonstrates ischemia) Tags: aaoca, management
Surgical Options¶
Q: What is the most common surgical procedure for AAOCA? A: Unroofing - creates neo-ostium in appropriate sinus Tags: aaoca, surgery, high-yield
Q: What are other surgical options for AAOCA? A: Reimplantation (if short intramural segment), ostioplasty (widen ostium) Tags: aaoca, surgery
Q: Why is CABG less favored for young AAOCA patients? A: Competitive flow issues with native coronary Tags: aaoca, cabg
Sports Participation¶
Q: Can an athlete with AAOLCA participate in sports? A: NO - restrict from competitive sports until repaired and cleared Tags: aaoca, sports, high-yield
Q: Can an athlete with asymptomatic AAORCA and negative stress test participate in sports? A: YES - may participate (Class IIa) with shared decision-making Tags: aaoca, sports, high-yield
Q: What is the return-to-sports timeline after AAOCA repair? A: After 3 months + normal stress perfusion testing + shared decision-making Tags: aaoca, return-to-play
Follow-up¶
Q: What follow-up is needed for repaired AAOCA? A: Confirm resolution of compression/ischemia on stress imaging; annual cardiology follow-up Tags: aaoca, follow-up