Coronary Artery Anomalies

Surgical Repair of a Cause of Sudden Death

“…14 In this group of patients, despite technical challenges, direct coronary reconstruction by unroofing the ostium and proximal part of LCA may be a reasonable surgical technique instead of bypass grafting, because there are some concerns about competitive flow and long-term patency of bypass to a coronary artery that is unobstructed or minimally obstructed under nonstressed conditions. 3,6,7,13 Our patient remains asymptomatic and the treadmill test is negative for evidence of myocardial ischemia in the postoperative year 2. Although there is limited data available about the long-term results of this technique, recently some authors reported favorable outcomes in the midterm period (mean 29 months; range 4-85 months).…”

“…This condition is believed by many to be another factor contributing to ischemia as a result of compression of LMCA between the great vessels. 3,6,7,14 In our case, we had to transect the main pulmonary artery to be able to have a clear vision during the unroofing procedure of LMCA. We were also concerned about the possible compression of the unroofed part of LMCA by the pulmonary artery when it was reapproximated.…”

“…Especially during exercise, increased systemic blood pressure might be another factor responsible for stretching of the aortic wall and compression of proximal and intramural parts of LCA. 1,3,6,7 Diagnosis of anomalous aortic origin of coronary artery may be difficult. Most of the patients (60%) are asymptomatic adolescents and young adults.…”

Coronary artery bypass grafting in infants, children, and young adults for acquired and congenital lesions

“…Coronary artery lesions in Kawasaki disease was first described by Kato et al in 1975. Aneurysms and ectasia are present in 12.8%–25% of patients with untreated Kawasaki disease, and represent the most common cause of acquired CA disease in children . The pathologic characteristics include vasculitis involving the arterioles, capillaries, and venules resulting in coronary wall segmental destruction and aneurysm formation .…”

“…Coronary anomalies are categorized by anomalous origin or abnormal course, lack of patency or stenosis, abnormal connections, and/or abnormal drainage . Congenital and acquired coronary lesions result in significant morbidity and mortality including myocardial dysfunction and sudden death.…”