1
|
Agrawal H, Lamari-Fisher A, Hasbani K, Philip S, Fraser CD, Mery CM. Decision making in anomalous aortic origin of a coronary artery. Expert Rev Cardiovasc Ther 2023; 21:177-191. [PMID: 36846957 DOI: 10.1080/14779072.2023.2184799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION There are many uncertainties surrounding anomalous aortic origin of a coronary artery (AAOCA) including the pathophysiology of sudden cardiac death, how to best risk stratify patients, how to best evaluate patients, who would benefit from exercise restriction, who should undergo surgical intervention, and which operation to perform. AREAS COVERED The goal of this review is to provide a comprehensive but succinct overview of AAOCA to help clinicians with the difficult task of navigating optimal evaluation and treatment of an individual patient with AAOCA. EXPERT OPINION Beginning in year 2012, some of our authors proposed an integrated, multi-disciplinary working group which has become the standard management strategy for patients diagnosed with AAOCA. A multi-disciplinary team with a focus on shared decision-making with the patients/families is likely necessary to optimize outcomes. Long-term follow-up and research are needed to improve our understanding of AAOCA.
Collapse
Affiliation(s)
- Hitesh Agrawal
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Alexandra Lamari-Fisher
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Keren Hasbani
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Stephanie Philip
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Charles D Fraser
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| |
Collapse
|
2
|
Jegatheeswaran A, DeCampli WM. Toward More Granular Guidelines in AAOCA: Associating Anatomical Details With Specific Surgical Strategies. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:63-74. [PMID: 36842800 DOI: 10.1053/j.pcsu.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
Patients with anomalous aortic origin of a coronary artery (AAOCA) require imaging to clarify the multiple potential anatomic sites of obstruction (fixed or dynamic). Once repaired, the pathway of blood to the myocardium must not encounter: (1) intrinsic ostial stenosis, (2) obstruction from compression or distortion near the commissure or the intercoronary pillar, (3) stenosis where the artery exits the aortic wall (due to an acutely angled "take-off"), (4) compression due to a pathway between the great vessels, (5) stenosis or compression along an intramural course, or (6) compression due to an intramuscular (intraseptal/intraconal) course. Detailed anatomic evaluation of each of these locations allows the surgeon to select an appropriate repair strategy, and each of these abnormal anatomic features should be "matched" with a particular surgical correction. We speculate that the most common surgical repair, unroofing with or without tacking, is often inadequate, as in isolation, it may not allow for correction with a large orifice from the appropriate sinus, without an interarterial course. While the evidence base is insufficient to call these recommendations formal guidelines, these recommendations should serve as a basis for further validity testing, and ultimate evolution to more granular guidelines on AAOCA management.
Collapse
Affiliation(s)
- Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London; Children's Cardiovascular Disease, Institute of Cardiovascular Sciences, University College London, London.
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida; Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, Florida
| |
Collapse
|
3
|
Anomalous Aortic Origin of Right Coronary Artery: Outcomes of Surgical and Nonsurgical Treatment. Ann Thorac Surg 2022; 114:2338-2345. [PMID: 34890570 DOI: 10.1016/j.athoracsur.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anomalous aortic origin of right coronary artery (AAORCA) is a congenital heart lesion that may be associated with coronary ischemia and sudden death; however, the management of these patients remains controversial. The aim of this study was to analyze all patients with AAORCA managed at our center. METHODS The medical records of patients with an isolated diagnosis of AAOCA were retrospectively reviewed, irrespective of symptoms, from 2007 to 2020. Follow-up was obtained by medical record review. AAORCA was diagnosed by echocardiogram and computed tomographic or magnetic resonance imaging studies in all patients. Treatment was based on anatomic, morphologic, and symptomatic features for patients older than 10 years with AAORCA. RESULTS The review identified 86 patients with a median age of 16 years; of these, 26 (30%) were managed surgically and 60 (70%) are monitored nonsurgically. Surgical intervention included a "classic" unroofing in 10 (39%), neo-ostial creation in 7 (27%), modified unroofing with neo-ostial creation in 6 (23%), a "classic" unroofing with reimplantation in 2 (7%), and reimplantation only in 1 (4%). Surgical patients were significantly older (P = .01), described more chest pain symptoms (P = .004), had the presence of slitlike ostia (P = .03), and longer length of coronary artery narrowing (P = .0002). At follow-up (median, 3 years; range, 0-13 years), 100% of surgical patients underwent functional testing and had no evidence of ischemia. Postoperative evaluation included one or more of echocardiography, computed tomographic angiogram, magnetic resonance imaging, and exercise stress test. CONCLUSIONS Our program uses a systematic approach for patients with AAORCA. With this paradigm, outcomes are excellent in the midterm, as validated with anatomic- and function-based testing.
Collapse
|
4
|
Bigler MR, Kadner A, Räber L, Ashraf A, Windecker S, Siepe M, Padalino MA, Gräni C. Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing. J Am Heart Assoc 2022; 11:e027098. [PMID: 36205254 DOI: 10.1161/jaha.122.027098] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are a challenge because of their various anatomic and clinical presentation. Although the prevalence is low, the absolute numbers of detected ACAOS are increasing because of the growing use of noninvasive anatomical imaging for ruling out coronary artery disease. As evidence-based guidelines are lacking, treating physicians are left in uncertainty for the optimal management of such patients. The sole presence of ACAOS does not justify surgical correction, and therefore a thorough anatomic and hemodynamic assessment is warranted. Invasive and noninvasive multimodality imaging provides information to the clinical question whether the presence of ACAOS is an innocent coincidental finding, is responsible for the patient's symptoms, or even might be a risk for sudden cardiac death. Based on recent clinical data, focusing on the pathophysiology of patients with ACAOS, myocardial ischemia is dependent on both the extent of fixed and dynamic components, represented by anatomic high-risk features. These varying combinations should be considered individually in the decision making for the different therapeutic options. This state-of-the-art review focuses on the advantages and limitations of the common contemporary surgical, interventional, and medical therapy with regard to the anatomy and pathophysiology of ACAOS. Further, we propose a therapeutic management algorithm based on current evidence on multimodality invasive and noninvasive imaging findings and highlight remaining gaps of knowledge.
Collapse
Affiliation(s)
- Marius Reto Bigler
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Alexander Kadner
- Centre for Congenital Heart Disease, Department of Cardiovascular Surgery Inselspital Bern Switzerland
| | - Lorenz Räber
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Afreed Ashraf
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Matthias Siepe
- Centre for Congenital Heart Disease, Department of Cardiovascular Surgery Inselspital Bern Switzerland
| | - Massimo Antonio Padalino
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardio-Thoracic and Vascular Sciences, and Public Health University of Padova, Medical School Padova Italy
| | - Christoph Gräni
- Department of Cardiology Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| |
Collapse
|
5
|
Barton J, Hussain A, Chaubey S, Mittal A, Khan H, Wendler O. Surgical management and long-term follow-up of aberrant right coronary arteries in adults. J Card Surg 2022; 37:1497-1502. [PMID: 35355326 DOI: 10.1111/jocs.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Anomalous origins of the right coronary artery (RCA) can cause ischaemia and sudden cardiac death, particularly if the RCA runs between the aorta and pulmonary artery. Conventional coronary artery bypass grafting (CABG) can be affected by early graft failure due to collateral blood flow. We present our institutional experience in managing patients with RCA anomalies. METHODS A single-center retrospective review of all patients who underwent surgery for aberrant right coronary arteries between 2005 and 2021 was conducted and in-hospital and long-term outcomes were analysed at our institution. RESULTS A total of 10 patients (5 females, median age: 51 years, 36-62) were identified. They presented with symptoms of chest pain (n = 8), dyspnoea (n = 1) or following cardiac arrest (n = 1). In the majority the RCA originated from the left coronary sinus (n = 9). In one of those patients and one in whom the RCA originated directly from the left anterior descending artery CABG was performed. The other 8 patients were treated using transfer of the RCA ostium. All patients were discharged home (median hospital stay 5 days, range: 4-10). Four patients experienced post-op atrial fibrillation. No other complications were observed. At a median follow-up of 10 years and 9 months, 9 patients were alive and free from cardiac symptoms. One patient died 3 years postsurgery due to liver failure, unrelated to cardiac disease. CONCLUSIONS In patients with an aberrant RCA, transfer of the ostium into the RCS carries a low surgical risk. It overcomes early graft failure in these patients, who present with a dynamic impairment in RCA blood flow. However, if fixed proximal RCA flow-limiting pathology exists, conventional bypass surgery is feasible.
Collapse
Affiliation(s)
- James Barton
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Azhar Hussain
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Aaina Mittal
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| |
Collapse
|
6
|
Amadou D, Mitchell J, Bulescu C, Metton O, Henaine R, Ninet J. Direct Reimplantation Procedure in Anomalous Aortic Origin of the Right Coronary Artery: Long-Term Single Center Outcomes. World J Pediatr Congenit Heart Surg 2021; 12:693-699. [PMID: 34846970 DOI: 10.1177/21501351211027478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anomalous aortic origin of the right coronary artery is known to be a cause of sudden cardiac death in athletes. There are no specific guidelines concerning treatment strategy in the literature. The aim of this study is to describe and report our experience of direct reimplantation technique in the treatment of this anomaly. METHODS This was a retrospective single center study of 30 patients who underwent surgery in the congenital heart disease unit of Louis Pradel Heart and Lung Hospital between January 2003 and December 2016. The mean follow-up was seven years (3 months-17 years). RESULTS Thirty patients underwent surgery. The median age was 17 years (0.2-52 years). There were 24 males. The median weight was 58 kg (3.6-118 kg). Fourteen patients were actively engaged in sports. Twenty-six patients had exertional chest pain or syncope. The median time lapse between diagnosis and intervention was 4.5 months (0.5-179 months). Twenty-seven (90%) patients underwent reimplantation of the anomalous coronary artery without transverse aortotomy, while in 3 (10%) patients transverse aortotomy was used to facilitate reimplantation to avoid tension at the anastomosis. There was no early death; one late death occurred in the third postoperative month. At the last follow-up, all patients had returned to normal physical activity without evidence of ischemia. CONCLUSIONS Direct reimplantation allows for a complete restoration of the coronary anatomy and enables patients to return to normal physical activity. Our study shows encouraging results using a direct reimplantation technique without aortotomy.
Collapse
Affiliation(s)
- Daouda Amadou
- Service de Chirurgie Cardiaque Congénitale, Hôpital Louis-Pradel, Hospices Civils de Lyon, Bron, France
| | - Julia Mitchell
- Service de Chirurgie Cardiaque Congénitale, Hôpital Louis-Pradel, Hospices Civils de Lyon, Bron, France
| | - Christian Bulescu
- Service de Chirurgie Cardiaque Congénitale, Hôpital Louis-Pradel, Hospices Civils de Lyon, Bron, France
| | - Olivier Metton
- Service de Chirurgie Cardiaque Congénitale, Hôpital Louis-Pradel, Hospices Civils de Lyon, Bron, France
| | - Roland Henaine
- Service de Chirurgie Cardiaque Congénitale, Hôpital Louis-Pradel, Hospices Civils de Lyon, Bron, France.,Université Claude Bernard, Laboratoire de Physiologie INSERM, Unité 1060, CarMen, Cardioprotection, Lyon, France
| | - Jean Ninet
- Service de Chirurgie Cardiaque Congénitale, Hôpital Louis-Pradel, Hospices Civils de Lyon, Bron, France.,Université Claude Bernard, Laboratoire de Physiologie INSERM, Unité 1060, CarMen, Cardioprotection, Lyon, France
| |
Collapse
|
7
|
Bonilla-Ramirez C, Molossi S, Caldarone CA, Binsalamah ZM. Anomalous Aortic Origin of the Coronary Arteries - State of the Art Management and Surgical Techniques. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:85-94. [PMID: 34116787 DOI: 10.1053/j.pcsu.2021.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/17/2021] [Accepted: 03/07/2021] [Indexed: 11/11/2022]
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) can be associated with myocardial ischemia and sudden cardiac arrest. We describe and compare the management and surgical techniques for patients with AAOCA. Patients presenting to the Coronary Artery Anomalies Program are evaluated and managed following a standardized approach. Our approach and data were compared to other single-center and multi-institutional data and results. Patients with AAOCA present as an incidental finding approximately 50% of the time. Advanced axial imaging is essential to define the anatomic characteristics of this lesion. Preoperative and postoperative assessment of myocardial perfusion with provocative testing is feasible and contributes to risk stratification. The surgical techniques for AAOCA repair include coronary unroofing, transection and reimplantation, and neo-ostium creation, among others. In general, surgical repair of AAOCA can mitigate the risk of ischemia with low mortality. The specific morbidities and complications of each different technique should be considered during the surgical planning. Surgical repair of AAOCA can mitigate the risk of ischemia with a low associated mortality but with clinically relevant morbidities. Long-term follow-up is necessary to accurately balance the risks of repaired and unrepaired AAOCA.
Collapse
Affiliation(s)
- Carlos Bonilla-Ramirez
- Coronary Artery Anomalies Program, Texas Children's Hospital; Houston, Texas; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Silvana Molossi
- Coronary Artery Anomalies Program, Texas Children's Hospital; Houston, Texas; The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Christopher A Caldarone
- Coronary Artery Anomalies Program, Texas Children's Hospital; Houston, Texas; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Ziyad M Binsalamah
- Coronary Artery Anomalies Program, Texas Children's Hospital; Houston, Texas; Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas.
| |
Collapse
|
8
|
Sayyouh M, Lee E, Bhave N, Kim K, Agarwal PP. Imaging and Management of Coronary Artery Anomalies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
9
|
Karangelis D, Mylonas KS, Loggos S, Adreanides E, Tzifa A, Mitropoulos F. Surgical repair of anomalous aortic origin of coronary artery in adults. Asian Cardiovasc Thorac Ann 2020; 29:51-58. [PMID: 32903023 DOI: 10.1177/0218492320957818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anomalous aortic origin of a coronary artery is a congenital abnormality of the origin or course of a coronary artery that arises from the aorta. The surgical treatment of this anomaly is highly variable and controversial and is achieved by implementing elaborate techniques of anatomic repair or by simple coronary artery bypass grafting. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers determined whether studies met the inclusion criteria. Eligible papers were published in English, clinical studies describing surgical repair of anomalous aortic origin of a coronary artery including coronary artery bypass in adults, and enrolled >5 patients. In the absence of multicentre trials, 7 single-center retrospective series were included, which demonstrated comparable short- and midterm outcomes of anatomic repair and coronary artery bypass in adults with anomalous aortic origin of a coronary artery. Coronary unroofing was the preferred technique when the anomalous artery has an intramural component, but there is a risk of aortic insufficiency. Anatomic repair is technically demanding and should be carried out in experienced centers. Coronary artery bypass with internal thoracic artery or vein grafts is technically straightforward with low operative risk and comparable midterm outcomes, however, long-term outcomes are unknown. Coronary artery bypass grafting is the technique of choice for older patients, in those with concomitant coronary artery disease, as a bailout procedure for failed anatomic repair, or in centers without experience in anatomic repair for anomalous aortic origin of a coronary artery.
Collapse
Affiliation(s)
| | | | - Spiros Loggos
- Department of Cardiac Surgery, Mitera Hospital, Athens, Greece
| | - Elias Adreanides
- Department of Cardiology, Medical Institution Military Shareholder Fund, Athens, Greece
| | - Aphrodite Tzifa
- Department of Congenital Cardiology, Mitera Hospital, Athens, Greece
| | | |
Collapse
|
10
|
Najm HK, Karamlou T, Ahmad M, Hassan S, Salam Y, Majdalany D, Ghobrial J, Stewart RD, Unai S, Pettersson G. Early Outcomes of Transconal Repair of Transseptal Anomalous Left Coronary Artery From Right Sinus. Ann Thorac Surg 2020; 112:595-602. [PMID: 32822667 DOI: 10.1016/j.athoracsur.2020.04.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/20/2020] [Accepted: 04/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anomalous aortic origin of the left coronary artery (AAOCLA) with an extended transseptal course behind the right ventricular outflow tract (RVOT) is a rare variant that poses challenges not addressed by current surgical techniques. We utilized a novel transconal approach in 7 consecutive patients. METHODS A retrospective review was made of a prospectively collected database for consecutive patients undergoing transconal unroofing of transseptal AAOLCA. Surgical repair entails transection of the RVOT, unroofing the septal course of the AAOLCA, followed by RVOT extension with a rectangular strip of autologous pericardium. Preoperative characteristics, operative details, and postoperative course were abstracted. RESULTS All 7 patients identified were symptomatic. Median age was 48 years (range, 12 to 62). The AAOLCA with transseptal course was confirmed by computed tomography angiography. Three patients had provocative testing demonstrating anterolateral ischemia. Four patients underwent cardiac catheterization with intravascular ultrasound and indexed fractional flow reserve, confirming flow-limiting lesion. Importantly, 3 patients had negative provocative noninvasive testing for ischemia. Median postoperative hospital length of stay was 6 days (range, 4 to 12). No mortality or major complications occurred during a median follow-up of 0.75 years. Postoperative evaluation demonstrated anatomically patent unroofed AAOLCA with improved indexed fractional flow reserve compared with preoperative (0.59 ± 0.16 vs 0.90 ± 0.03, P = .05). CONCLUSIONS Complete unroofing of AAOLCA with transseptal course repaired with posterior extension of RVOT is an effective technique with excellent early outcome. Multimodality provocative testing is critical to evaluate these lesions as individual studies may be misleading. Intravascular ultrasound with indexed fractional flow reserve is clinically useful to confirm the hemodynamic significance of specific lesions.
Collapse
Affiliation(s)
- Hani K Najm
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Tara Karamlou
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Munir Ahmad
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Saad Hassan
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Yezan Salam
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David Majdalany
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Joanna Ghobrial
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Robert D Stewart
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Division of Pediatric Cardiac Surgery, Akron Children's Hospital, Akron, Ohio
| | - Shinya Unai
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gosta Pettersson
- Division of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
11
|
|
12
|
Molossi S, Martínez-Bravo LE, Mery CM. Anomalous Aortic Origin of a Coronary Artery. Methodist Debakey Cardiovasc J 2019; 15:111-121. [PMID: 31384374 DOI: 10.14797/mdcj-15-2-111] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.
Collapse
Affiliation(s)
- Silvana Molossi
- TEXAS CHILDREN'S HOSPITAL, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| | - Luis E Martínez-Bravo
- ESCUELA DE MEDICINA, TECNOLOGICO DE MONTERREY, MONTERREY, MEXICO.,UNIVERSITY OF TEXAS DELL MEDICAL SCHOOL, DELL CHILDREN'S MEDICAL CENTER, AUSTIN, TEXAS
| | - Carlos M Mery
- TEXAS CHILDREN'S HOSPITAL, BAYLOR COLLEGE OF MEDICINE, HOUSTON, TEXAS
| |
Collapse
|
13
|
Agati S, Secinaro A, Caldaroni F, Calvaruso D, Manuri L, Gitto P, Ferro G, Anderson R, Vouhè PR, Zanai R, Campanella I. Perfusion Study Helps in the Management of the Intraseptal Course of an Anomalous Coronary Artery. World J Pediatr Congenit Heart Surg 2019; 10:360-363. [PMID: 31084306 DOI: 10.1177/2150135119829004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.
Collapse
Affiliation(s)
- Salvatore Agati
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Aurelio Secinaro
- 2 Imaging Department-"Bambino Gesù" Pediatric Hospital, Rome, Italy
| | | | - Davide Calvaruso
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Lucia Manuri
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Placido Gitto
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Giuseppe Ferro
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Robert Anderson
- 3 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Pascal R Vouhè
- 3 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rosanna Zanai
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| | - Ivana Campanella
- 1 Mediterranean Pediatric Heart Center "Bambino Gesù", Taormina, Italy
| |
Collapse
|
14
|
Abstract
Anomalies in the coronary arterial circulation have been described since classical antiquity by Galen and through the Medical Renaissance by Vesalius, but their clinical significance and association with sudden cardiac death (SCD) has only been appreciated over the last 4 decades. Advances in cardiac surgery and cardiovascular intensive care have led to decreasing overall postoperative mortality and morbidity associated with cardiac surgery. The decision whether to surgically treat an anomaly of coronary artery origin and course, and the risk-to-benefit ratio of surgical treatment in preventing a potentially lethal complication of SCD, requires careful, deliberate consideration based on the best available evidence. In this keynote lecture, we aim to deliver a concise discussion of the current surgical management of anomalous coronary arteries.
Collapse
Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.,Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Marshall L Jacobs
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| |
Collapse
|
15
|
Kloesel B, Richtsfeld M, Konia M, Bass JL. Management and Anesthetic Considerations for Patients With Anomalous Aortic Origin of a Coronary Artery. Semin Cardiothorac Vasc Anesth 2018; 22:383-394. [PMID: 30095030 DOI: 10.1177/1089253218793888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The term "coronary artery anomalies" encompasses a large and heterogeneous group of disorders that may affect origin, intrinsic anatomy, course, location, and termination of the coronary arteries. With these different anatomies, presentation, symptoms, and outcomes are heterogeneous as well. While significant efforts are directed toward improving diagnosis and risk-stratification, best evidence-guided practices remain in evolution. Data about anesthetic management of patients with coronary anomalies are lacking as well. This review aims to provide the anesthesiologist with a better understanding of an important subgroup of coronary artery anomalies: anomalous aortic origin of a coronary artery. We will discuss classification, pathophysiology, incidence, evaluation, management, and anesthetic implications of this potentially fatal disease group.
Collapse
Affiliation(s)
- Benjamin Kloesel
- 1 Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Martina Richtsfeld
- 1 Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Mojca Konia
- 1 Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - John L Bass
- 1 Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
16
|
Imoto Y, Matsuba T, Kanda H, Ogata Y, Nagatomi S, Ueno K. Reimplantation of an anomalous left coronary artery with a malignant course. Asian Cardiovasc Thorac Ann 2018; 26:473-475. [PMID: 29911388 DOI: 10.1177/0218492318782263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 14-year-old boy was diagnosed with an anomalous left coronary artery coursing between the ascending aorta and the main pulmonary artery and associated with a single coronary ostium. Owing to the high risk of sudden cardiac death, surgery was performed although he was asymptomatic with no sign of myocardial ischemia. Reimplantation of an anomalous left coronary artery is generally considered difficult because an aortic cuff is unavailable for coronary anastomosis; however, we accomplished a successful direct reimplantation in this patient. This procedure offers another choice in the surgical treatment of anomalous left coronary artery.
Collapse
Affiliation(s)
- Yutaka Imoto
- 1 Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomoyuki Matsuba
- 1 Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hideaki Kanda
- 1 Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuki Ogata
- 1 Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shuji Nagatomi
- 1 Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kentaro Ueno
- 2 Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| |
Collapse
|
17
|
Sousa H, Casanova J. Coronary artery abnormalities: Current clinical issues. Rev Port Cardiol 2018; 37:227-235. [DOI: 10.1016/j.repc.2017.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 11/25/2022] Open
|
18
|
Sousa H, Casanova J. Coronary artery abnormalities: Current clinical issues. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
19
|
Abdelhady K, Durgam S, Elzein C, Ilbawi MN, Rhoiney D, Massad MG. Surgical Correction of Aberrant Right Coronary Anomalies Stranding an Aortic Commissure with and Without Unroofing. Pediatr Cardiol 2017; 38:1080-1083. [PMID: 28214965 DOI: 10.1007/s00246-017-1581-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
Abstract
The technique for successful surgical correction of an anomalous origin of the right coronary artery from the opposite aortic cusp with an aberrant course between the aorta and pulmonary artery is illustrated in a symptomatic 62-year-old woman. The intramural course of the right coronary artery traversed the tip of the commissure between the anterior and posterior leaflets, and its repair entailed unroofing of the intramural segment from inside the aortic intima. This technique required resuspension of the overlying commissure to maintain optimal aortic valve leaflet coaptation and prevent aortic insufficiency. Modifications of this technique have been utilized by us whenever the intramural segment traversed behind the commissure. In these cases, partial or subtotal unroofing of the intramural segment was performed to preserve the integrity of the intima behind the overlying commissure. More recently, we have performed the surgical correction by probing the intramural segment within the aortic wall to its most anterior location and then performing a wide anterior unroofing in the aortic intima, and marsupializing the aortic and coronary intima to avoid dissection or intimal flap development. We favor utilizing these techniques of anatomic correction of the anomalous coronary to other techniques involving coronary artery bypass grafting of the anomalous coronary, especially in adult patients, as unroofing provides more lasting results.
Collapse
Affiliation(s)
- Khaled Abdelhady
- Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
- Division of Cardiothoracic Surgery, University of Illinois at Chicago, 840 S. Wood St., CSB Suite 417 (MC 958), Chicago, IL, 60612, USA.
| | - Samarth Durgam
- Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Chawki Elzein
- Advocate Hope Children's Hospital, The Heart Institute for Children, Chicago, IL, USA
| | - Michel N Ilbawi
- Advocate Hope Children's Hospital, The Heart Institute for Children, Chicago, IL, USA
| | - David Rhoiney
- Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Malek G Massad
- Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
20
|
Mosca RS, Phoon CKL. Anomalous Aortic Origin of a Coronary Artery Is Not Always a Surgical Disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 19:30-6. [PMID: 27060040 DOI: 10.1053/j.pcsu.2015.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/11/2022]
Abstract
Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has become a high-profile lesion as a result of its association with sudden cardiac death in otherwise young and healthy individuals. Despite our incomplete knowledge of its pathophysiology and natural history, surgical intervention is often recommended. Evidence now shows AAOCA to be relatively common, with lower than previously suspected rates of sudden cardiac death. Analysis of this information reveals that AAOCA is not always a surgical disease. Future multi-institutional studies will continue to define those subgroups best served by observation or surgery.
Collapse
Affiliation(s)
- Ralph S Mosca
- George E. Reed Professor of Cardiac Surgery Vice Chairman, Clinical Affairs, Chief, Division of Congenital Cardiac Surgery, NYU Langone Medical Center, New York, NY
| | - Colin K L Phoon
- Division of Pediatric Cardiology, NYU Langone Medical Center, New York, NY.
| |
Collapse
|
21
|
Refatllari A, Likaj E, Dumani S, Hasimi E, Goda A. Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis. Open Access Maced J Med Sci 2016; 4:131-4. [PMID: 27275346 PMCID: PMC4884233 DOI: 10.3889/oamjms.2016.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND An anomalous origin of the right coronary artery is rarely observed, with a reported incidence between 0.026% and 0.25%. This condition is often completely asymptomatic and is found incidentally during angiographic evaluation for other cardiac diseases. However some patients present with exertion angina or sudden death. Surgical treatment in patients with anomalous RCA is still controversial. Treatment can be conservative, angioplasty or surgery. CASE PRESENTATION A 59-year-old man was admitted with severe mitral stenosis. He complained exertion and rest dyspnea, NYHA III class. He had sequels of embolic stroke, results of left atrial thrombus. Echocardiography showed calcified severe mitral stenosis with mitral orifice area of 1.1 square centimeters with PSPAP 60 mmHg and normal LV function. Routine coronary angiography before surgery showed aberrant origin of RCA from the left sinus of Valsalva with 90% stenosis at his origin. Multi-slice computed tomography proved the diagnosis of anomalous RCA arising from the left sinus of Valsalva and taking an inter-arterial course between the aorta and pulmonary artery. The patient underwent mitral valve replacement with mechanical St. Jude prosthesis No 29 and saphenous vein graft to RCA. We chose by-pass grafting techniques because after aortotomy, RCA was too close to LMCA, intramural course was too short and stenosis of RCA was outside of aortic wall. The patient's perioperative course was without complications and patient was discharged on the seventh postoperative day. CONCLUSION Correction of anomalous of the origin of right coronary artery is mandatory in cases where patient has to be operated for other cardiac causes.
Collapse
Affiliation(s)
- Ali Refatllari
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Ermal Likaj
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Selman Dumani
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Endri Hasimi
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| | - Artan Goda
- Department of Cardiovascular Surgery, University Hospital Centre "Mother Theresa", Rruga e Dibres, N. 370, Tirana, Albania
| |
Collapse
|
22
|
Abstract
Anomalous aortic origins of the coronary arteries comprise approximately one-third of all coronary artery anomalies and are characterised by coronary arteries with anomalies of aortic origin involving abnormal courses, stenoses, and compression that can lead to myocardial ischaemia and sudden death. Operative techniques to treat these anomalies have not been standardised yet. Moreover, the management of potential complications has not been addressed. Common and rare forms of anomalous aortic origins of the coronary arteries are reviewed and understood standard techniques for an uncomplicated unroofing procedure are illustrated. Also noted are techniques that can be applied to unexpected anatomical findings and unwanted complications that could prove to be life-threatening. Several technical recommendations are offered.
Collapse
|
23
|
Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature. Case Rep Cardiol 2015; 2015:806291. [PMID: 26257964 PMCID: PMC4518180 DOI: 10.1155/2015/806291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/01/2015] [Indexed: 11/17/2022] Open
Abstract
Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery.
Collapse
|
24
|
Poynter JA, Bondarenko I, Austin EH, DeCampli WM, Jacobs JP, Ziemer G, Kirshbom PM, Tchervenkov CI, Karamlou T, Blackstone EH, Walters HL, Gaynor JW, Mery CM, Pearl JM, Brothers JA, Caldarone CA, Williams WG, Jacobs ML, Mavroudis C, DeCampli WM, Fiore AC, Huddleston CB, Weinstein S, Bondarenko I, Walters HL, Moga FX, Morales DL, Blackstone EH, Jacobs JP, Kanter KR, Mavroudis C, Poynter JA, Jacobs ML, Austin EH, Tchervenkov CI, Pearl JM, Gruber PJ, Mainwaring RD, Mery CM, Brothers JA, Gaynor JW, Caldarone CA, McCrindle BW, Wilder TJ, Williams WG, Karamlou T, Ziemer G, St. Louis JD, Ricci M, Kirshbom PM. Repair of Anomalous Aortic Origin of a Coronary Artery in 113 Patients. World J Pediatr Congenit Heart Surg 2014; 5:507-14. [DOI: 10.1177/2150135114540182] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA) encompasses a wide morphologic spectrum, which has impeded consensus regarding indications for the diverse repair strategies. We constructed a profile of current surgical techniques and explore their application to morphologic variants. Methods: Patients <30 years old (n = 113) with isolated AAOCA who underwent operations at 29 Congenital Heart Surgeons Society (CHSS) institutions from 1998 to 2012 were identified from the CHSS AAOCA Registry. Operative findings were related to surgical techniques at index repairs by cross-tabulation. Results: Anomalous origin of the left main or left anterior descending coronary artery was present in 33 (29%) patients and of the right coronary artery in 78 (69%) patients; 2 arteries originated directly above the commissure between the left and right sinuses. There were 101 (89%) interarterial and intramural (IA/IM) arteries, 10 (9%) were interarterial but not intramural (IA/NIM) and 2 (2%) were neither interarterial nor intramural. Intramural arteries were unroofed in 100 (88%) operations, usually with intimal tacking after incision (n = 47) or excision (n = 25) of the common wall. Coronary reimplantation (n = 11), pulmonary artery relocation (n = 7; 5 for IA/NIM), simple ostioplasty (without unroofing; n = 3), coronary artery bypass grafting (n = 2), and ostial window (n = 1) were less common. In 37 (33%) operations, a valvar commissure was taken down; 33 were resuspended. Conclusion: Current surgical repair of AAOCA is individualized to morphology, particularly the presence of intramural and/or interarterial segments. This report is foundational for future planned CHSS studies that will examine interventional and noninterventional outcomes and ultimately guide management of AAOCA.
Collapse
Affiliation(s)
- Jeffrey A. Poynter
- Congenital Heart Surgeons Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Igor Bondarenko
- Department of Cardiovascular Surgery, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Erle H. Austin
- Kosair Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - William M. DeCampli
- Department of Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Jeffrey P. Jacobs
- Johns Hopkins All Children's Heart Institute, Johns Hopkins University, All Children's Hospital, St Petersburg, FL, USA
| | - Gerhard Ziemer
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | | | | | - Tara Karamlou
- Department of Pediatric Cardiac Surgery, University of California-San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | - Henry L. Walters
- Department of Cardiovascular Surgery, Children’s Hospital of Michigan, Detroit, MI, USA
| | - J. William Gaynor
- Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carlos M. Mery
- Division of Congenital Heart Surgery, Texas Children’s Hospital, Houston, TX, USA
| | - Jeffrey M. Pearl
- Glendale Department of Childhealth, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Julie A. Brothers
- Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher A. Caldarone
- Division of Cardiac Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William G. Williams
- Congenital Heart Surgeons Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marshall L. Jacobs
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Anomalous origin of a coronary artery from the aorta is a potentially serious anomaly that occurs in about 0.1-0.2% of the population. This percentage is small; however, it translates into about 4000 annual births with these anomalies. The clinical presentation of these anomalies is rare, and hence most are and will remain asymptomatic. The various anatomic anomalies are described, with anomalous origin of the left coronary artery that then passes between the aorta and pulmonary artery being the most serious of these anomalies. The pathophysiology resulting from these anomalies is described, as are methods for identifying those who require treatment; however, we still do not know the best methods of determining which patients need treatment.
Collapse
|
26
|
Surgical Unroofing of Anomalous Aortic Origin of a Coronary Artery: A Single-Center Experience. Ann Thorac Surg 2014; 98:941-5. [DOI: 10.1016/j.athoracsur.2014.04.114] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 11/19/2022]
|
27
|
Coronary Artery Anomalies: Current Recognition and Treatment Strategies. Update on Recent Progress. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0395-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
28
|
Li J, Lai H, Zheng J, Guo C, Gu J, Wang C. Patch repair of anomalous origin of the left main coronary artery from the anterior aortic sinus. Ann Thorac Surg 2014; 97:e59-61. [PMID: 24580950 DOI: 10.1016/j.athoracsur.2013.08.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/17/2013] [Accepted: 08/27/2013] [Indexed: 10/25/2022]
Abstract
Anomalous origin of the left main coronary artery from the anterior aortic sinus is a rare but potentially lethal congenital disease. We report two adolescent patients with this anomaly who underwent surgical plasty using a saphenous vein patch, rather than unroofing or fenestration technique, as was typically done. This report suggests that surgical angioplasty can be performed safely and effectively to treat this anomaly.
Collapse
Affiliation(s)
- Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiayu Zheng
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changfa Guo
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiawei Gu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
29
|
Mainwaring RD, Reddy VM, Reinhartz O, Petrossian E, Punn R, Hanley FL. Surgical repair of anomalous aortic origin of a coronary artery. Eur J Cardiothorac Surg 2014; 46:20-6. [PMID: 24431169 DOI: 10.1093/ejcts/ezt614] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect that has been associated with myocardial ischaemia and sudden death. There is an ongoing controversy over the indications for surgical intervention and the efficacy of that treatment compared with the natural history. The purpose of this study was to evaluate the medium-term results of surgical repair of AAOCA. METHODS Seventy-six patients underwent surgical repair of AAOCA at our institution from 1999 to 2013. There were 55 males and 21 females, and the median age at surgery was 15 years. Forty-seven (62%) of the 76 patients had an anomalous right coronary artery, 27 had an anomalous left coronary and 2 had an eccentric single coronary ostia. Forty-one patients had preoperative symptoms of myocardial ischaemia. RESULTS Surgical repair was accomplished by unroofing of an intramural coronary in 55, reimplantation in 7 and pulmonary artery translocation in 14. There has been no early or late mortality, with a median duration of follow-up of 6 years. One patient presented with severe myocardial ischaemia and subsequently underwent heart transplantation a year following AAOCA surgery. The remaining patients have all remained free of cardiac symptoms. CONCLUSIONS The results of this study demonstrate two major principles. First, surgical repair of AAOCA is quite safe in centres that take care of a significant number of patients with this entity. Secondly, the surgery is highly effective in eliminating symptoms of myocardial ischaemia. The growing amount of data on postoperative patients suggests that surgical repair can prevent the adverse events seen in the untreated 'natural' history. Based on these observations, it is our current recommendation that all teenagers identified with AAOCA should undergo surgical repair.
Collapse
Affiliation(s)
- Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - V Mohan Reddy
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Olaf Reinhartz
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Oakland Children's Hospital, Oakland, CA, USA
| | - Edwin Petrossian
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Children's Hospital of Central California, Madera, CA, USA
| | - Rajesh Punn
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Oakland Children's Hospital, Oakland, CA, USA Division of Pediatric Cardiac Surgery, Children's Hospital of Central California, Madera, CA, USA
| |
Collapse
|
30
|
Nguyen AL, Haas F, Evens J, Breur JMPJ. Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course : Case report and review of the literature. Neth Heart J 2012; 20:463-71. [PMID: 23055055 PMCID: PMC3491136 DOI: 10.1007/s12471-012-0324-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised.
Collapse
Affiliation(s)
- A. L. Nguyen
- Department of Paediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - F. Haas
- Department of Paediatric Cardiothoracic Surgery, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - J. Evens
- Department of Paediatric Cardiothoracic Surgery, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| | - J. M. P. J. Breur
- Department of Paediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands
| |
Collapse
|
31
|
Peñalver JM, Mosca RS, Weitz D, Phoon CKL. Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord 2012; 12:83. [PMID: 23025810 PMCID: PMC3502461 DOI: 10.1186/1471-2261-12-83] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 08/27/2012] [Indexed: 01/31/2023] Open
Abstract
Background Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has received much attention due to its association with sudden death in otherwise healthy individuals. AAOCA is relatively common and may have significant public health implications. While our knowledge of its pathophysiology and natural history remains incomplete, an emphasis has been placed on surgical correction. Discussion In 2005 we published a review examining the rates of sudden death with AAOCA, as well as complications of surgical management. Evidence now points even more strongly to lower rates of sudden death, while surgical outcomes data now better documents associated risks. Summary Armed with this updated information, we agree with the need for a national registry to better track patients with AAOCA. We submit that the risks of surgical management outweigh any benefits in the asymptomatic patient with anomalous right coronary artery, and expectant management should also be strongly considered even in asymptomatic patients with anomalous left coronary artery.
Collapse
Affiliation(s)
- Josiah M Peñalver
- Division of Pediatric Cardiology, Department of Pediatrics, 160 East 32nd Street, L-3, New York, NY 10016, USA.
| | | | | | | |
Collapse
|
32
|
Abstract
Anomalous origination of a coronary artery from the opposite sinus (ACAOS) is estimated to be present in 0.2-2.0% of the population. In the majority of individuals, ACAOS has no hemodynamic or prognostic implications, but in a minority of cases, typically where the anomalous coronary artery takes an interarterial course to reach its correct myocardial territory, it can precipitate ischemia and sudden cardiac death (SCD). With the growing use of CT coronary angiography (CTCA) in the investigation of ischemic heart disease, we can expect increasing rates of incidental detection of this anomaly. Although CTCA and magnetic resonance coronary angiography can effectively characterize these lesions anatomically, they fail to describe and quantitatively assess the basic defect that leads to coronary insufficiency, such as mural intussusception. The key challenge lies in the identification of which patients are at risk of SCD and, therefore, who should be offered corrective surgical or (potentially) percutaneous intervention. Conventional, noninvasive stress testing has limited sensitivity, but emerging, invasive stress tests, which utilize intravascular ultrasonography and measurements of fractional flow reserve, show the potential to provide more-accurate hemodynamic and prognostic assessment.
Collapse
Affiliation(s)
- Joanna C E Lim
- The Wiltshire Cardiac Centre, Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK
| | | | | | | |
Collapse
|
33
|
Intramural Coronary Length Correlates With Symptoms in Patients With Anomalous Aortic Origin of the Coronary Artery. Ann Thorac Surg 2011; 92:986-91; discussion 991-2. [DOI: 10.1016/j.athoracsur.2011.04.112] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 04/21/2011] [Accepted: 04/26/2011] [Indexed: 11/23/2022]
|
34
|
Anomalous Aortic Origin of a Coronary Artery: Medium-Term Results After Surgical Repair in 50 Patients. Ann Thorac Surg 2011; 92:691-7. [DOI: 10.1016/j.athoracsur.2011.03.127] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 11/21/2022]
|
35
|
Van der Mieren G, Van Kerrebroeck C, Gutermann H, Dion R. Surgical angioplasty and unroofing technique for intramural coronary anomaly. Interact Cardiovasc Thorac Surg 2011; 13:424-6. [PMID: 21798889 DOI: 10.1510/icvts.2011.276592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A malign intramural course of the left main coronary artery is a rare anatomical anomaly. Surgical repair is mandatory since the condition is associated with myocardial ischemic syndromes and sudden death. Unroofing the intramural part and reconstructing a neo-ostium is challenging if the neo-ostium is immediately adjacent to the intercoronary commissure as there is a risk of narrowing the newly created ostium. We report a case in which we performed a surgical angioplasty of the left main coronary artery in combination with unroofing of the intramural section and resuspension of the intercoronary commissure.
Collapse
Affiliation(s)
- Gerry Van der Mieren
- Department of Cardiac Surgery, Hospital ZOL Genk, Schiepse Bos 6, 3600 Genk, Belgium
| | | | | | | |
Collapse
|
36
|
Said SM, Burkhart HM, Phillips SD, Dearani JA. Left Main Coronary Artery Compression by Right Ventricle-to-Pulmonary Artery Conduit Relieved by Anterior Translocation of the Right Pulmonary Artery. World J Pediatr Congenit Heart Surg 2011; 2:502-4. [PMID: 23804005 DOI: 10.1177/2150135111403780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary artery translocation has been described as an alternative surgical strategy to treat anomalous aortic origin of the coronary artery from the wrong sinus of Valsalva. We describe another application of this strategy in a patient who underwent complete repair of pulmonary atresia with ventricular septal defect and presented years later with ischemic symptoms due to compression of the left main coronary artery by the right ventricular-to-pulmonary artery conduit. To our knowledge, this is the first application of the pulmonary artery translocation technique to treat such a problem.
Collapse
Affiliation(s)
- Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | |
Collapse
|
37
|
Abstract
The most commonly reported coronary arterial malformation, in accounts of sudden deaths, is anomalous aortic origin of a coronary artery. Anomalous coronary arteries may arise from the left, right, or non-coronary sinuses of Valsalva. Importantly, although the left coronary artery from the right sinus has the worst prognosis, sudden death has been reported in all variants of origin from the various sinuses of Valsalva. This paper describes a technique that addresses all of the problems relating to anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva. This technique includes the transection of the ascending aorta and pulmonary trunk, coronary arterial enlargement with a pericardial patch, and lateral translocation of the pulmonary trunk to the left pulmonary artery. Anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva is a potentially lethal cardiac anomaly that can be corrected in all cases using this simplified surgical technique that addresses the major anatomic and physiological problems.
Collapse
|
38
|
Abstract
Congenital anomalies of the coronary arteries are an uncommon, but important, cause of pain in the chest, myocardial ischaemia and even sudden cardiac death, especially in young individuals. This paper focuses on the surgical treatment of congenital anomalies of the coronary arteries in adults; indications for surgery and the different surgical options will be reviewed.
Collapse
|
39
|
Anomalous coronary arteries from the opposite sinus of Valsalva in asymptomatic siblings treated with pulmonary arterial translocation. J Thorac Cardiovasc Surg 2010; 140:1430-2. [DOI: 10.1016/j.jtcvs.2010.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 05/07/2010] [Accepted: 05/16/2010] [Indexed: 11/21/2022]
|
40
|
Yanagawa B, Alghamdi AA, Chen RB, Amankwaa A, Verma S. Coronary artery bypass graft for anomalous right coronary artery. J Card Surg 2010; 26:44-6. [PMID: 21039851 DOI: 10.1111/j.1540-8191.2010.01116.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A 27-year-old man with anomalous right coronary artery (RCA) presented with ventricular fibrillatory arrest. Computed tomography angiography revealed an anomalous RCA arising from the left sinus of Valsalva with an acute angulation at the coronary takeoff and compressed interarterial segment. This patient underwent a short saphenous vein coronary artery bypass graft to the proximal RCA and recovered uneventfully. A review of the literature and discussion of the surgical management is presented.
Collapse
Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
41
|
Karimi M, Murdison K, Blackwood W, Davis W. Reimplantation of anomalous right coronary artery from left main coronary artery: a surgical option. Interact Cardiovasc Thorac Surg 2010; 10:642-4. [PMID: 20061336 DOI: 10.1510/icvts.2009.226464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anomalous right coronary artery (ARCA) from left sinus of Valsalva could present in several forms either being intramural or extramural, and most occurring with separate ostium from left coronary system. ARCA originating from the left main coronary artery (LMCA) is very rare and treatments proposed for this type of anomaly are pulmonary artery translocation or coronary artery bypass grafting (CABG) of the right coronary system. There has not been any report in the literature of successful reimplantation of ARCA from LMCA, to the best of our knowledge, as another surgical option for this anomaly. We are reporting a case of successful surgical reimplantation of an ARCA from LMCA.
Collapse
Affiliation(s)
- Mohsen Karimi
- Department of Surgery, Section of Pediatric Cardiothoracic Surgery, The Children's Heart Center at Medical College of Georgia, 1446 Harper Street, BP-3107, Augusta, GA 30912, USA
| | | | | | | |
Collapse
|
42
|
Mavroudis C, Backer CL. Technical Tips for Three Congenital Heart Operations: Modified Ross-Konno Procedure, Optimal Ventricular Septal Defect Exposure by Tricuspid Valve Incision, Coronary Unroofing and Endarterectomy for Anomalous Aortic Origin of the Coronary Artery. ACTA ACUST UNITED AC 2010. [DOI: 10.1053/j.optechstcvs.2009.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
43
|
Kayalar N, Burkhart HM, Dearani JA, Cetta F, Schaff HV. Congenital coronary anomalies and surgical treatment. CONGENIT HEART DIS 2009; 4:239-51. [PMID: 19664026 DOI: 10.1111/j.1747-0803.2009.00301.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coronary artery anomalies are not uncommon, occurring in 1.3% (range = 0.3-5.6%) of the population, and are often an incidental finding in asymptomatic patients. Approximately 20% of coronary anomalies have potential for life-threatening complication, including myocardial infarction, arrhythmia, or sudden death early in life or during adulthood. Coronary artery anomalies are composed of a wide variety of disorders. Some, such as anomalous location of a coronary ostium, duplication of coronary arteries, or multiple ostia, become clinically significant only when another cardiac surgical procedure is necessary, and generally, surgical correction is not required in these patients. On the other hand, the diagnosis of anomalous origin of left coronary artery from pulmonary artery or from the opposite sinus with inter-arterial course is an indication for operation. Some anomalies like coronary artery fistulas, myocardial bridging, and coronary aneurysm require operation only when they cause clinical symptoms. Coronary artery anomalies should be included in the differential diagnosis of anginal symptoms, myocardial infarction, arrhythmia, or heart failure, especially in young patients. Increased awareness of these pathologies will lead to earlier diagnosis and treatment of a potentially life-threatening condition.
Collapse
Affiliation(s)
- Nihan Kayalar
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA
| | | | | | | | | |
Collapse
|
44
|
Lee BY, Song KS, Jung SE, Jung JI, Chun HJ, Park CB, Kim CK, Cho EJ, Jin U, Jung HO. Anomalous Right Coronary Artery Originated From Left Coronary Sinus With Interarterial Course. J Comput Assist Tomogr 2009; 33:755-62. [DOI: 10.1097/rct.0b013e318190d68c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
45
|
Surgical Management of Anomalous Aortic Origin of a Coronary Artery. Ann Thorac Surg 2009; 88:844-7; discussion 847-8. [DOI: 10.1016/j.athoracsur.2009.06.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/30/2009] [Accepted: 06/04/2009] [Indexed: 12/13/2022]
|
46
|
|
47
|
Gulati R, Reddy VM, Culbertson C, Helton G, Suleman S, Reinhartz O, Silverman N, Hanley FL. Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches. J Thorac Cardiovasc Surg 2007; 134:1171-8. [DOI: 10.1016/j.jtcvs.2007.02.051] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Revised: 01/29/2007] [Accepted: 02/14/2007] [Indexed: 10/22/2022]
|
48
|
Weininger M, Bonz A, Beer M, Hahn D, Beissert M. Multi-slice cardiac computed tomography reveals anomalous origin of the right coronary artery between the great arteries. Int J Cardiol 2007; 119:e77-8. [PMID: 17537531 DOI: 10.1016/j.ijcard.2007.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/01/2007] [Indexed: 11/27/2022]
Abstract
We report a case of a 72-year-old man whose multi-slice cardiac computed tomography revealed an anomalous origin of the right coronary artery between the great arteries.
Collapse
|
49
|
Alphonso N, Anagnostopoulos PV, Nölke L, Moon-Grady A, Azakie A, Raff GW, Karl TR. Anomalous Coronary Artery From the Wrong Sinus of Valsalva: A Physiologic Repair Strategy. Ann Thorac Surg 2007; 83:1472-6. [PMID: 17383360 DOI: 10.1016/j.athoracsur.2006.10.071] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 10/23/2006] [Accepted: 10/24/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND A coronary artery arising from the wrong aortic sinus, with or without a proximal course between the aorta and the pulmonary artery, may predispose to myocardial ischemia, myocardial infarction, or sudden death. METHODS We repaired this lesion in 5 symptomatic patients, all of whom had experienced exercise-related chest pain, dyspnea, or syncopal episodes. All patients underwent patch angioplasty of the proximal anomalous coronary artery with glutaraldehyde-treated autologous pericardium. When the coronary artery coursed between the aorta and the main pulmonary artery, the main pulmonary artery was translocated toward the left pulmonary artery to create additional space and prevent compression. RESULTS All patients recovered well and to date have demonstrated no evidence of recurrent myocardial ischemia. CONCLUSIONS The combination of coronary artery angioplasty and translocation of the pulmonary artery seems to effectively address all the mechanisms that can generate ischemia.
Collapse
Affiliation(s)
- Nelson Alphonso
- Pediatric Heart Center, UCSF Children's Hospital, University of California San Francisco, San Francisco, California 94143, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Erez E, Tam VKH, Doublin NA, Stakes J. Anomalous Coronary Artery With Aortic Origin and Course Between the Great Arteries: Improved Diagnosis, Anatomic Findings, and Surgical Treatment. Ann Thorac Surg 2006; 82:973-7. [PMID: 16928518 DOI: 10.1016/j.athoracsur.2006.04.089] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 04/25/2006] [Accepted: 04/27/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anomalous origin of a coronary artery with subsequent coursing between the great vessels is a rare congenital heart defect that may cause myocardial ischemia and sudden death. Because of the fatality rate of this anomaly, many are diagnosed at the postmortem examination, and reports of surgical correction are few. We present our experience with the diagnosis and surgical treatment of this rare coronary anomaly. METHODS Between June 2003 and August 2005, 9 patients (8 males) were diagnosed with anomalous origin of a coronary artery coursing between the great vessels. The mean age was 12 +/- 5.8 years (range, 4 months to 23 years). Three patients had an intramural origin of the coronary artery. One infant had a single coronary artery and was diagnosed during follow-up of other heart defects. The 8 older patients all presented with exertional syncope or chest pain and echocardiography was used for the initial diagnosis. Six patients had coronary artery reimplantation in the correct aortic sinus, 2 patients had unroofing of the intramural coronary segment, and 1 patient had pericardial patch enlargement of his right coronary artery before reimplantation. One patient, the infant, awaits repair at an older age. RESULTS No postoperative deaths occurred. The mean hospital stay was 5.5 +/- 1.2 days (range, 4 to 8 days). Three patients had transient ST segment changes during the first 24 hours postoperatively. Follow-up was 4 months to 2.5 years. All patients underwent an exercise myocardial perfusion scan 3 months postoperatively without evidence of myocardial ischemia, and all patients remain clinically well. CONCLUSIONS Echocardiography imaging of young patients with exertional syncope or chest pain is reliable for the diagnosis of this coronary anomaly. It is surgically correctable; however, individual coronary anatomy may cause the surgical approach to vary. The postoperative outcome is excellent.
Collapse
Affiliation(s)
- Eldad Erez
- Cook Children's Medical Center, University of North Texas, Fort Worth, Texas 76104, USA.
| | | | | | | |
Collapse
|