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Background: Anomalous aortic origin of a coronary artery (AAOCA) is the second most common cause of sudden cardiac death in youth during exertion. An optimal method to risk stratify patients with AAOCA and atypical symptoms is yet to be defined.

Hypothesis: Invasive intracoronary hemodynamic flow measurement can be helpful in scenarios when there is conflict between clinical presentation and non-invasive studies.

Methods: Case series of patients <21 years old with AAOCA who underwent cardiac catheterization with instantaneous wave-free ratio (iFR)/fractional flow reserve (FFR) measurement at baseline and during adenosine and dobutamine infusion. Baseline iFR <0.89 and/or FFR <0.8 were considered hemodynamically significant. All patients underwent dobutamine stress cardiac MRI to evaluate for inducible myocardial ischemia during provocative stress. Post-op assessment was described in …