{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T22:30:05Z","timestamp":1787351405122,"version":"build-2736575974"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Anomalous aortic origin of a right coronary artery may cause myocardial ischemia and sudden death in the young. Data on myocardial ischemia or longitudinal outcomes are sparse in pediatric anomalous aortic origin of a right coronary artery population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients &lt;21 years with anomalous aortic origin of a right coronary artery were prospectively enrolled. Computerized tomography angiography defined morphology. Exercise stress test and stress perfusion imaging (sPI) were performed if &gt;7 years or younger with concern for ischemia. High-risk features included intramural length, slit-like\/hypoplastic ostium, exertional symptoms, or evidence of ischemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 220 patients (60% males) were enrolled December 2012 to April 2020 at a median age 11.4 years (interquartile range, 6.1\u201314.5), including 168 (76%) with no\/nonexertional symptoms (group 1) and 52 (24%) with exertional chest pain\/syncope (group 2). Computerized tomography angiography was available in 189\/220 (86%), exercise stress test in 164\/220 (75%), and sPI in 169\/220 (77%). Exercise stress test was positive in 2\/164 (1.2%) patients in group 1, both had positive sPI. Inducible ischemia (sPI) was detected in 11\/120 (9%) in group 1 and 9\/49 (18%) in group 2 (\n                      <jats:italic>P<\/jats:italic>\n                      =0.09). Intramural length was similar in patients with\/without ischemia (5 [interquartile range, 4\u20137] versus 5 [interquartile range, 4\u20137] mm;\n                      <jats:italic>P<\/jats:italic>\n                      =0.65). Surgery was recommended in 56\/220 (26%) patients with high-risk features. In 52 surgical patients (38 unroofing, 14 reimplantation), all subjects were alive and have returned to exercise at last median follow-up of 4.6 (interquartile range, 2.3\u20136.5) years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Anomalous aortic origin of a right coronary artery patients can present with inducible ischemia on sPI despite symptoms or intramural length. Exercise stress test is a poor predictor of ischemia and caution should be given to determine low-risk based solely on this assessment. All patients are alive at medium-term follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.122.012631","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T14:00:56Z","timestamp":1681826456000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Large Pediatric Cohort Medium-Term Outcomes"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8256-1535","authenticated-orcid":true,"given":"Tam T.","family":"Doan","sequence":"first","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children\u2019s Hospital, Houston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1919-870X","authenticated-orcid":true,"given":"Shagun","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children\u2019s Hospital, Houston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Bonilla-Ramirez","sequence":"additional","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.H.H.), Baylor College of Medicine, Texas Children\u2019s Hospital, Houston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2010-3467","authenticated-orcid":true,"given":"Dana L.","family":"Reaves-O\u2019Neal","sequence":"additional","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children\u2019s Hospital, Houston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Masand","sequence":"additional","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"Department of Pediatric Radiology (P.M.), Baylor College of Medicine, Texas Children\u2019s Hospital, Houston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0779-2381","authenticated-orcid":true,"given":"Carlos M.","family":"Mery","sequence":"additional","affiliation":[{"name":"Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School\/Dell Children\u2019s Medical Center, Austin (C.M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyad","family":"Binsalamah","sequence":"additional","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.H.H.), Baylor College of Medicine, Texas Children\u2019s Hospital, Houston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey H.","family":"Heinle","sequence":"additional","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.H.H.), Baylor College of Medicine, Texas Children\u2019s Hospital, Houston."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9767-9512","authenticated-orcid":true,"given":"Silvana","family":"Molossi","sequence":"additional","affiliation":[{"name":"Coronary Artery Anomalies Program, Texas Children\u2019s Hospital, Houston (T.T.D., S.S., C.B.-R., D.L.R.-O., P.M., Z.B., J.H.H., S.M.)."},{"name":"The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics (T.T.D., S.S., D.L.R.-O., S.M.), Baylor College of Medicine, Texas Children\u2019s Hospital, 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