Dr. Naser Ammash is a Professor of Medicine, Mayo Clinic College of Medicine, and a Consultant in Cardiovascular Department at Mayo Clinic. He is Board Certified in Cardiovascular Diseases, with subspecialty certification in Adult Congenital Heart Disease and Echocardiography. He is also a specialist in congenital aortic diseases. Dr. Ammash attended the American University of Beirut- Lebanon and moved to the United States in 1987. He has been at the Mayo clinic in Rochester since 1994.
Dr. Ammash details the stroke risk in CHD patients with the risk 6-8 percent higher in women and 8-9 percent in men, with some conditions featuring extremely high risks.
They also touch on how irregular heart beats and heart failure are the most severe risk factors, with age playing a role as well, noting the special cases of Eisenmenger Syndrome patients and how that increases risk factors.
Tools for risk stratification are explained, leading into an in depth discussion into all aspects of treatment with anti-coagulants.
Lastly, they cover important guidelines to follow while carrying for the patients.
Congenital Coronary Artery Anomalies can be of four types: Ectopic Coronary Artery Origin, Coronary Artery Aneurysm, Coronary Artery Fistulae, and the most common, Coronary Artery Bridge.
As detailed by Mayo Clinic Adult Congenital Heart Disease expert Naser Ammash, M.D. in the video below, the majority of these anomalies are benign, but some such as ectopic coronary artery origin can be life threatening.
He shares that Coronary Artery Anomalies are the second or third most common cause of sudden death among athletes under 35 of age and less so among older individuals involved in recreational sports. The most malignant congenital coronary artery anomaly usually involves an Anomalous origin of left coronary artery from the opposing right coronary sinus or from Pulmonary Artery. Dr. Ammash illustrates what that means, how it affects the heart, the potential reasons for symptoms and what treatment options are available.
Other, more common ectopic coronary artery anomalies explained by Dr. Ammash are usually benign but can be a concern depending on the course of the anomalous coronary artery such as when it runs between the aorta and pulmonary artery.
He shares with us the details of a case involving a 49-year-old with a coronary artery anomaly and describes how to assess such patient in regards to risk of sudden cardiac death, the role of stress testing, monitoring and imaging.
Dr. Ammash describes the very important role of CT scan imaging in the evaluation of these anomalies including the difference between intramural, extramural and intramyocardial courses of the ectopic coronary artery.
Furthermore, he notes the potential role of cardiac catheterization with intravascular coronary ultra-sound in the evaluation of a select group of these patients as it allows direct assessment of the stenosis created by these anomalies which might help in the decision making regarding treatment.
Lastly, Dr. Ammash reviews the biggest takeaways from his explanation of Risk Stratification of Anomalous Coronary Arteries and shares important things to remember in regards to this condition and his recommendations on when to consider treatment.
Anomalous pulmonary venous connections are a rare and simple congenital heart defect when they occur in isolation. However, in many patients, they are associated with other congenital heart diseases such as atrial septal defect or Tetralogy of Fallot.
Transthoracic echocardiogram, transesophageal echocardiogram, CT scan, and MRI can all be used to identify anomalous pulmonary venous connections, and treatment can often times require surgical repair.