{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:48:19Z","timestamp":1792054099946,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["GR\u20102019\u201012369116"],"award-info":[{"award-number":["GR\u20102019\u201012369116"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anomalous Aortic Origin of a Coronary Artery (AAOCA) high\u2010risk anatomical features (intramural segment, acute take\u2010off angle, slit\u2010like ostium) cause coronary stenosis leading to myocardial infarction. How these features alter coronary physiology remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to evaluate their impact on coronary blood supply using continuous thermodilution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively enrolled 51 AAOCA patients undergoing continuous thermodilution. Subjects were classified into an ischemic risk (IR) group (intramural segment, acute angle, oval or slit ostium) or non\u2010ischemic risk (no\u2010IR) group. Non\u2010anomalous coronary arteries served as controls. We measured absolute coronary blood flow (CBF) and microvascular resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Subjects (median age 48.4 years) presented mostly with angina, syncope, and arrhythmia. Final analysis included 48 AAOCA cases (31 IR, 17 no\u2010IR) and 45 controls. The IR group had a median IM length of 9\u2009mm, take\u2010off angle of 31.9\u00b0, and a slit\u2010like or oval ostium. The no\u2010IR group had a median angle of 51.5\u00b0 and an oval or round ostium. At rest, absolute CBF and microvascular resistance showed no significant differences among groups. However, during hyperemia, the IR group had significantly reduced CBF compared to controls (179 vs. 290\u2009mL\/min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015). The IR group demonstrated higher microvascular resistance at rest (1473 vs. 1150,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024) and during hyperemia (433 vs. 305,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012), indicating persistently increased coronary vascular tone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High\u2010risk anatomical features of AAOCA are associated with altered coronary physiology. An intramural segment, acute take\u2010off angle, and slit\u2010like or oval ostium are linked to reduced hyperemic coronary blood flow due to increased microvascular resistance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70891","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:21:09Z","timestamp":1792052469000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impaired Flow and Physiology in Coronaries With Anomalous Origin From the Opposite Sinus of Valsalva"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3175-3764","authenticated-orcid":false,"given":"Mauro","family":"Lo Rito","sequence":"first","affiliation":[{"name":"Department of Pediatric and Adult Congenital Cardiac Surgery IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1979-3130","authenticated-orcid":false,"given":"Mattia","family":"Squillace","sequence":"additional","affiliation":[{"name":"Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9150-0788","authenticated-orcid":false,"given":"Mauro Luca","family":"Agnifili","sequence":"additional","affiliation":[{"name":"Interventional Cardiology, IRCCS MultiMedica, Sesto San Giovanni Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3975-913X","authenticated-orcid":false,"given":"Antonio","family":"Rosato","sequence":"additional","affiliation":[{"name":"3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7423-9757","authenticated-orcid":false,"given":"Serena","family":"Anglese","sequence":"additional","affiliation":[{"name":"3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8291-8052","authenticated-orcid":false,"given":"Adele","family":"Chiavetta","sequence":"additional","affiliation":[{"name":"3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Muritti","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Cardiac Surgery IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9087-4053","authenticated-orcid":false,"given":"Miriam","family":"Deamici","sequence":"additional","affiliation":[{"name":"Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Negri","sequence":"additional","affiliation":[{"name":"Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato San Donato Milanese Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8007-2324","authenticated-orcid":false,"given":"Andrea","family":"Attanasio","sequence":"additional","affiliation":[{"name":"Cardiology University Department IRCCS Policlinico San Donato San Donato Milanese Italy"},{"name":"Multimodality Cardiac Imaging Unit, IRCCS Policlinico San Donato San Donato Milanese 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