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4.5.1. Anomalous Aortic Origin of a Coronary Artery
COR LOE Recommendations
Diagnostic
1 B-NR
1. In adults with suspected anomalous origin of a coronary
artery (AAOCA), coronary CT angiography or MR
angiography (if CT angiography is contraindicated) is
recommended to confirm the anatomic diagnosis and guide
management.
1 B-NR
2. In adults with an AAOCA from the opposite sinus, risk
stratification with evaluation for physiological and/or
ischemic changes should be performed to guide management.
erapeutic
1 B-NR
3. In adults with symptomatic AAOCA or diagnostic evidence
consistent with myocardial ischemia attributable to the
anomalous artery, surgery is recommended.
2a C-EO
4. In adults with asymptomatic anomalous origin of the left
coronary artery, surgery is reasonable in the presence of high-
risk anatomy.*
2b B-NR
5. In asymptomatic adults with an AAOCA from the opposite
sinus and without evidence of ischemia or evidence of
compromised coronary perfusion, the benefit of surgery is
not well established, and continued observation or surgery
may be reasonable.
* High-risk findings such as ostial or proximal stenosis, slit-like orifice, acute angle of takeoff,
or intramural course.
4.5. Coronary Artery Anomalies
