Pattern, behavior, and clinical implications of electrocardiographic changes in patients undergoing repair of anomalous aortic origin of coronary arteries

Stephen B Williams; Tam Dan N Pham; Tam T Doan; Dana Reaves-O'Neal; Carlos Bonilla-Ramirez; Ziyad M Binsalamah; Carlos M Mery; Christopher A Caldarone; Silvana Molossi

doi:10.1016/j.jtcvs.2022.01.047

Pattern, behavior, and clinical implications of electrocardiographic changes in patients undergoing repair of anomalous aortic origin of coronary arteries

J Thorac Cardiovasc Surg. 2022 Sep;164(3):742-749. doi: 10.1016/j.jtcvs.2022.01.047. Epub 2022 Feb 16.

Authors

Stephen B Williams¹, Tam Dan N Pham¹, Tam T Doan², Dana Reaves-O'Neal², Carlos Bonilla-Ramirez³, Ziyad M Binsalamah³, Carlos M Mery⁴, Christopher A Caldarone³, Silvana Molossi⁵

Affiliations

¹ The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, Tex.
² The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, Tex; Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex.
³ Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital & Baylor College of Medicine, Houston, Tex.
⁴ Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Tex.
⁵ The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, Tex; Coronary Artery Anomalies Program, Texas Children's Hospital, Houston, Tex. Electronic address: smolossi@bcm.edu.

PMID: 35279290
DOI: 10.1016/j.jtcvs.2022.01.047

Abstract

Objectives: Surgical repair in anomalous aortic origin of a coronary artery aims at mitigating the risk of sudden cardiac death in a subset of patients. The pattern and behavior of electrocardiogram changes in a large cohort of these patients are lacking. We aim to describe postoperative electrocardiogram changes in this population and its clinical implications on follow-up.

Methods: All patients aged less than 21 years who underwent surgical repair for anomalous aortic origin of a coronary artery between December 2012 and June 2020 at our institution were considered for inclusion. Electrocardiograms were reviewed at 5 defined time intervals, from preoperative to 90-day follow-up, with attention to significant findings of ST-segment changes, abnormal T waves, and pathologic Q waves. The electrocardiogram changes were analyzed for correlation with surgical reintervention and medium-term outcomes.

Results: Sixty-two patients met inclusion criteria (median age 13.7 years, 61% male). ST-segment changes in the initial postoperative period were seen in 52 patients (84%), all resolving over time. Abnormal T waves were seen in 19 patients (31%), occurred commonly at the predischarge period, and mostly resolved over time. Pathologic Q waves were observed in only 1 patient and associated with reintervention due to coronary artery stenosis. There was no association between postoperative electrocardiogram changes and inducible myocardial ischemia, ventricular dysfunction, or restriction from exercise at follow-up.

Conclusions: ST-segment changes and T-wave abnormalities are commonly seen in the postoperative period after anomalous aortic origin of a coronary artery repair, tend to resolve over time, and are not associated with adverse medium-term outcomes. Pathologic Q waves were associated with the need for early coronary reintervention.

Keywords: AAOCA; anomalous coronary artery; coronary anomalies; postoperative ECG.

MeSH terms

Adolescent
Aorta
Coronary Vessel Anomalies* / complications
Coronary Vessel Anomalies* / surgery
Coronary Vessels* / diagnostic imaging
Coronary Vessels* / surgery
Death, Sudden, Cardiac / etiology
Female
Humans
Male
Retrospective Studies