Surgery for Anomalous Aortic Origin of the Coronary Artery

Mumtaz, Muhammad Ali; Lorber, Richard; Arruda, Janine; Pettersson, Gösta; Mavroudis, Constantine

doi:10.1016/j.athoracsur.2010.11.002

Cited by 66 publications

(49 citation statements)

References 10 publications

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“…Surgical treatment has been widely proposed, aiming at removing any risk of myocardial ischemia and SCD. Single-center studies are based on limited series describing surgical repair as safe and effective [7][8][9][10][11][12][13], although late effects on symptoms and risk of SCD are undefined and concerns about the surgical effectiveness remain [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Padalino

Franchetti

Sarris

et al. 2019

International Journal of Cardiology

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Background: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. Methods: This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Results: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p b 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p b 0.001). Conclusions: Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal

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Section: Introductionmentioning

confidence: 99%

Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study

Padalino

Franchetti

Sarris

et al. 2019

International Journal of Cardiology

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“…Total unroofing procedure for the intramural segment crossing the aortic valve commissure would require detachment of the commissure which could result in AI [5].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical approaches include total unroofing procedure, creation of a neo-ostium without total unroofing of the intramural segment and direct coronary reimplantation [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Patch angioplasty and neo-ostium creation for intramural left coronary artery

Ito

Takabayashi

Kajimoto

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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Anomalous aortic origin of the coronary artery is a rare cardiac anomaly which induces myocardial ischemia and is associated with sudden death. We operated on a 25-year-old female with syncopal episodes who had an intramural left coronary artery. A neo-ostium was created in the left sinus but the initial neo-ostium seemed small because of the hypoplastic intramural segment of the left coronary artery. Therefore, saphenous vein patch angioplasty was added for ostial enlargement. The patient was symptom-free at one year follow-up and exercise stress test was negative for ischemia.

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“…Table 1 summarizes the results from the largest surgical series for treatment of AAOCA available in the literature. 30,[33][34][35][36][37][38][39][40] The complication rate is reported to be 7%-20% with no operative mortality. Long-term results have overall been good although up to 15% of patients may have symptoms postoperatively.…”

Section: Coronary Artery Bypass Graft Surgerymentioning

confidence: 98%

“…34 This procedure avoids taking down the aortic valve but requires the presence of a long intramural segment within the exit sinus of Valsalva.…”

Section: Creation Of a Neo-ostiummentioning

confidence: 99%