PT  - JOURNAL ARTICLE
AU  - Leonardo De Luca
AU  - Francesco Bovenzi
AU  - Domenico Rubini
AU  - Artor Niccoli-Asabella
AU  - Giuseppe Rubini
AU  - Italo de Luca
TI  - Stress-Rest Myocardial Perfusion SPECT for Functional Assessment of Coronary Arteries with Anomalous Origin or Course
DP  - 2004 Apr 01
TA  - Journal of Nuclear Medicine
PG  - 532--536
VI  - 45
IP  - 4
4099  - http://jnm.snmjournals.org/content/45/4/532.short
4100  - http://jnm.snmjournals.org/content/45/4/532.full
SO  - J Nucl Med2004 Apr 01; 45
AB  - Anomalous coronary arteries (ACAs) may be clinically silent and totally benign or associated with catastrophic and fatal presentations. It has been postulated that the proximal course of an ACA is a decisive factor in risk stratification and surgical approach. Particularly, a course between the aorta and pulmonary trunk carries a high risk of major adverse events. We sought to evaluate the anatomic course of documented ACAs by transesophageal echocardiography (TEE) and to study their functional importance using stress–rest 99mTc-sestamibi (99mTc-MIBI) myocardial perfusion SPECT. Methods: From a cohort of patients undergoing coronary angiography in our department between January 1997 and April 2003, we selected 14 with ACAs but without CAD (9 men and 5 women; mean age, 50.7 ± 14.6 y). All patients underwent TEE and stress–rest 99mTc-MIBI myocardial perfusion SPECT. Results: TEE correctly identified the origin of all ACAs and revealed an anomalous course between the great vessels in 5 patients. At exercise myocardial perfusion SPECT, 4 of 14 patients demonstrated a reversible myocardial perfusion defect. All these patients had an anomalous course between the aorta and pulmonary artery. Conclusion: In this study, 4 of 5 (80%) anomalous courses between the aorta and pulmonary artery were associated with the finding of a reversible perfusion defect on stress–rest SPECT. An integrated evaluation of anatomic course and hemodynamic importance could be useful in the management of ACA.