A clinical-angiographic risk scoring system for coronary artery anomalies.

Congenital coronary anomalies remain a debated issue. On the basis of a critical review of the literature and our historical series, we propose a simple clinical profile scoring system for congenital coronary anomalies. A review of literature over the past 30 years was performed, searching for a relationship between the worst coronary anomaly presentation and manifestations and the anatomical and functional features. A risk scoring system was created based on these features, and retrospectively applied to our historical series of 140 consecutive patients (52 females; mean age, 60.1±19.3 years; mean follow-up, 60±23 months). Origin from the pulmonary artery, intramural course, intramyocardial course, coronary fistula with a significant pulmonary-to-systemic flow ratio, superimposed coronary artery disease, and associated congenital heart disease were associated with the worst clinical presentation. The risk scoring system gave 2 points to anatomical features and 1 point to the association with clinical and functional characteristics: 3 risk classes were identified: >3, 2-3, and <2 points. The system showed good correlation with presentation and manifestations on follow-up. Although not exhaustive, the proposed scoring system may simplify the clinical evaluation of patients with such abnormalities, being a model for decision making.

Education, and obtaining of informed consent, using multimedia before adults with congenitally malformed hearts are submitted to transcatheter interventions.

BACKGROUND: Multimedia programmes relating to education and consents may be useful for decreasing anxiety during catheter-based repair in patients with congenitally malformed hearts. OBJECTIVE: Our study was aimed at evaluating the impact of multimedia protocols for education of a population of consecutive patients with congenitally malformed hearts prior to transcatheter repair. METHODS: Between September, 2006, and May, 2008, we enrolled 100 consecutive patients, with a mean age of 45 +/- 19 years, of whom 69 were female, for catheter-based repair of their congenitally malformed hearts. In the first 50 patients, we used a written form for informed consent sent to the patients 15 days before the procedure, coupled with a personal interview of 30 minutes. In the subsequent 50 patients, we used multimedia protocol for education, comprising a booklet of 4 pages containing a simple and brief explanation of the intervention, and a digital film of 4 minutes showing the transcatheter procedure with a commentary provided by the referring physician, prior to obtaining the signature for informed consent. We then compared the scores for anxiety, the pre-operative heart rate, the frequency of vaso-vagal episodes, and the need for conscious sedation between the two groups. RESULTS: Patients who underwent preconditioning using the multimedia programme were significantly less anxious, and had significantly lower heart rates. Vaso-vagal episodes were also significantly less in this group, with no episodes compared to 14% in those providing standard informed consent. Conscious sedation was needed more frequently in those providing standard informed consent. CONCLUSION: Our brief study suggests that a comprehensive multimedia programme of preparation increases the tolerability, and decrease the emotional state, of adults about to undergo catheter-based interventions for congenital cardiac disease.