AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • PAFCIC 2021 Abstracts December 2021 14 MODERATED POSTER SESSION 1 Submission ID: 997 ANOMALOUS ORIGIN OF THE LEFT CORONARY ARTERY FROM THE NON-CORONARY CUSP: ABOUT A SCARCE CASE OF A TUNISIAN ADULT WAEL YAAKOUBI, SLIM BOUDICHE, BASSEM REKIK, FOURAT ZOUERI, ABDEJELIL FARHATI, FATHIA MGHAITH, SANA OUALI, MARWA BEN DOUDOU, MANEL BEN HLIMA, MED SAMI MOURALI LA RABTA, TUNISIA Background: Anomalous origin of the left coronary artery from the noncoronary cusp (LCANCC) is extremely rare and its prognosis and management are still controversial. The anomalous aortic origin of the coronary arteries (AAOCA) occurs in up to 0.7% of the general population. Despite its extremely low prevalence, it is the second most common cardiovascular cause of sudden cardiac death (SCD). There are scarce reports of left coronary artery (LCA) arising from the non-coronary cusp (LCANCC), which is one of the rarest forms of coronary anomalies. Furthermore, the true prevalence, prognosis, risk stratification strategies, and management options for this specific coronary anomaly have not been well-defined. Case presentation: A 38 -year-old woman presented for evaluation after multiple emergency room (ER) visits with atypical chest pain over the last three years. She denied dyspnea on exertion or syncope. The electrocardiogram was normal. Troponins were repeatedly negative. Computed tomography coronary angiogram (CCTA) was performed. The LCA had an anomalous origin from the non-coronary sinus of Valsalva followed a retro-aortic, and then bifurcated into the left anterior descending (LAD), and left circumflex arteries (LCX). Left coronary arteries were hypoplastic and the left main was small and widely dominated by a large right coronary artery RCA originated from the right coronary cusp. There was no evidence of coronary atherosclerosis or myocardial bridging. A basic coronary angiography was performed revealing the same constatations of the CT scan but technically, the left main intubation was difficult given its course and size. Intravascular ultrasound (IVUS) showed a left main coronary artery with a minimal luminal area of 27 mm2. Transthoracic Echocardiogram showed normal size of left ventricle (LVEF was about 60 %), the contractility of the LV was preserved without mitral regurgitation mitral regurgitation (MR). Left coronary artery birth site is blind end and its path was retro aortic arising from the non-coronary cusp the right coronary artery birth-site and path were normal. The right ventricle (RV) was normal. Speckle tracking (GLS) was about -22%. Based on these images and clinical findings, the decision for coronary artery bypass of LAD was made. Conclusion: Although LCANCC is fairly rare, the potential risk of sudden cardiac death and other adverse complications make accurate diagnosis and treatment of this condition crucial to maximizing patient out. Submission ID: 1040 ACCELERATION TIME AND RATIO OF ACCELERATION TIME TO EJECTION TIME: ECHOCARDIOGRAPHIC DIAGNOSTIC PARAMETERS IN AORTIC STENOSIS Mariem Mediouni, SARRA CHENIK, Houaida Mahfoudhi, Karima Taamallah, Wafa Fehri Cardiology Department, Military Hospital of Tunis, Tunisia Background: Assessing aortic stenosis severity is essential for its correct management. The echocardiographic evaluation of AS can sometimes be tricky and inconsistencies can be found between gradients and aortic valve areas. The aim of our study was to evaluate the role of acceleration time (AT), ejection time (ET) and their ratio (AT/ET) in AS diagnosis. Methods: 50 Patients with AS (aortic peak velocity > 2 m/sec) were prospectively included. Quantitative echocardiographic Doppler parameters including ejection dynamics (AT, ET, and AT/ET ratio) as well as conventional and clinical parameters were analyzed. AT, ET, and AT/ET ratio were calculated in different stages of AS. Results: 50 patients were included in our study (54% of men, mean age of 72 ±10 years) of whom 36 (72 %) had sever AS, 12 (24%) had mild AS and 2 (4%) had moderate AS. Most of our patients (92%) had a normal systolic function with a mean EF of 58% and all of them had classic normal flow high gradient AS. AT and AT/ ET ratio were higher in patients with higher levels of severity of AS. Significant correlation was found between AT and the classic echocardiographic parameters of AS: peak velocity (p=0.01), mean gradient (p=0.005) and aortic valve area (p=0.023). AT/ET ratio was as well significantly correlated with these parameters: peak velocity (p=0.16), mean gradient (p=0.012) and aortic valve area. Both of these dynamic parameters had poor correlation with DVI (p= 0.3 and 0.4 respectively). On multivariate analysis, AT was associated with aortic orifice area (p=0.04). A cutoff value of 94.5ms for AT had a sensitivity of 97% for severe AS and a cut-off value of 0.300ms for AT/ET ratio had a sensitivity of 97.2%. Conclusion: Ejection parameters such as AT and AT/ET are valuable parameters to help evaluate AS severity.
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