Hemodynamic Relevance Evaluation of Coronary Artery Anomaly During Stress Using FFR/IVUS in an Artificial Twin

Anomalous aortic origin of coronary artery can lead to ischemia. Due to the limitations of invasive catheterization dobutamine stress testing, an alternative noninvasive approach is desired. A 65-year-old woman with atypical chest pain was referred for coronary computed tomography angiography. Although coronary artery disease was excluded, a right anomalous aortic origin of coronary artery with an interarterial and intramural course was discovered. The patient underwent invasive coronary angiography with a dobutamine stress test, which revealed a pathologic fractional flow reserve (ie, dobutamine fractional flow reserve) of 0.76 (normal >0.8) and lateral ostial compression in dobutamine intravascular ultrasound. A physical replication, using a patient-specific 3-dimensional-printed phantom was created based on coronary computed tomography angiography and evaluated in a flow loop under the same hemodynamic rest and stress conditions. The 3-dimensional-printed phantom fractional flow reserve was similar with 0.78, and dobutamine intravascular ultrasound showed comparable lateral compression.