Surgical Repair of 115 Patients With Anomalous Aortic Origin of a Coronary Artery From a Single Institution

Mainwaring, Richard D.; Murphy, Daniel J.; Rogers, Ian S.; Chan, Frandics P.; Petrossian, Edwin; Palmon, Michal; Hanley, Frank L.

doi:10.1177/2150135116641892

Cited by 69 publications

(62 citation statements)

References 26 publications

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“…In our experience, surgical indication was in accordance with the most accepted expert consensus surgical guidelines [24,25], despite some intercenter variability. As in other surgical series [10][11][12][13][14], unroofing of the intramural segment was the commonest procedure (56.4%), whose protective effect from AE (OR 0.31, Table 3) is to be related to excision of the intervening roof of the intramural segment, (causing coronary compression and ischemia during effort), the enlargement of the slit like orifice and its relocation to the appropriate sinus, and the elimination of the interarterial course. Coronary reimplantation was favoured when the intramural segment was too short or absent, while CABG procedure was performed in 24 patients at a significantly higher age.…”

Section: Discussionmentioning

confidence: 53%

“…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%

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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: Discussionmentioning

confidence: 53%

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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“…If surgery is required in symptomatic patients with AAOLCA and subpulmonic course the focus is to abolish potential compression of the intraconal portion of the left coronary artery. This can be achieved by division of muscle fibers overlying the coronary artery and by anterior translocation of the pulmonary artery using a modified LeCompte manoeuvre [12]. This approach represents an extensive surgical procedure and it should be reserved to symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Anomalous origin of the left coronary artery from the right aortic sinus: probably benign variant associated with a subpulmonic intramyocardial course – a case report

et al. 2020

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Background: Anomalous aortic origin of the left coronary artery (AAOLCA) from the right aortic sinus is a rare congenital anomaly associated with significantly increased risk of myocardial ischemia, arrhythmias and sudden cardiac death. This refers specifically to AAOLCA associated with interarterial and/or intramural course. Much less is known about anomalous origin of the left coronary artery from the right aortic sinus associated with a subpulmonic intramyocardial course. Case presentation: We report a 12 year old girl who complained of recurrent episodes of chest pain lasting for some minutes and not associated to exercise. Echocardiography revealed AAOLCA from the right aortic sinus taking a subpulmonic course within the conal septum. The diagnosis was confirmed by CT-scan and selective coronary angiography. Treadmill test, Holter-ECG and bicycle-stress echocardiography revealed no evidence of myocardial ischemia reflecting unimpaired diastolic flow in the left coronary artery. According to the nature of the complaints and in the absence of signs of myocardial ischemia the episodes of chest pain were classified as idiopathic and not associated to the coronary anomaly. We opted for a conservative approach with regular follow-up visits. During a follow-up of 2 years without restriction of sports activities the patient has been asymptomatic. Conclusion: According to the literature AAOLCA with subpulmonary intramyocardial course appears to be associated with significantly less clinical problems than AAOLCA taking an interarterial course. The diagnosis can be suspected based on echocardiography and confirmed by contrast-enhanced computed tomography. Until now there are only few data concerning the natural history and incidence of complications in this specific anomaly. Despite the probably benign nature we recommend regular follow-up examinations including stress-testing in these patients.

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“…Single-centre studies report on limited series, describing surgical repair as safe and effective [6][7][8][9][10][11][12], although late effects on symptoms and risk of SCD are undefined and concerns about the surgical effectiveness remain [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Surgery for anomalous aortic origin of coronary arteries: a multicentre study from the European Congenital Heart Surgeons Association†

Padalino

Franchetti

Hazekamp

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES: We sought to describe early and late outcomes in a large surgical series of patients with anomalous aortic origin of coronary arteries. METHODS: We performed a retrospective multicentre study including surgical patients with anomalous aortic origin of coronary arteries since 1991. Patients with isolated high coronary takeoff and associated major congenital heart disease were excluded. RESULTS: We collected 156 surgical patients (median age 39.5 years, interquartile range 15–53) affected by anomalous right (67.9%), anomalous left (22.4%) and other anatomical abnormalities (9.6%). An interarterial course occurred in 86.5%, an intramural course in 62.8% and symptoms in 85.9%. The operations included coronary unroofing (56.4%), reimplantation (19.2%), coronary bypass graft (15.4%) and other (9.0%). Two patients with preoperative cardiac failure died postoperatively (1.3%). All survivors were discharged home in good clinical condition. At a median follow-up of 2 years (interquartile range 1–5, 88.5% complete), there were 3 deaths (2.2%), 9 reinterventions in 8 patients (5 interventional, 3 surgical); 91.2% are in New York Heart Association functional class ≤ II, but symptoms persisted in 14.2%; 48.1% of them returned to sport activity. On Kaplan–Meier analysis, event-free survival at follow-up was 74.6%. Morbidity was not significantly different among age classes, anatomical variants and types of surgical procedures. Furthermore, return to sport activity was significantly higher in younger patients who participated in sports preoperatively. CONCLUSIONS: Surgical repair of anomalous aortic origin of coronary arteries is effective and has few complications. Unroofing and coronary reimplantation are safe and are the most common procedures. The occurrence of late adverse events is not negligible, and long-term surveillance is mandatory. Most young athletes can return to an unrestrained lifestyle.

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Surgical Repair of 115 Patients With Anomalous Aortic Origin of a Coronary Artery From a Single Institution

Abstract: Surgical repair of AAOCA can be safely performed and is highly efficacious in relieving symptoms of myocardial ischemia. The two "surgical failures" in this series had an anatomic basis and underscore the need to reassess both the proximal and distal anatomy in these patients.

Cited by 69 publications

References 26 publications

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

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

Anomalous origin of the left coronary artery from the right aortic sinus: probably benign variant associated with a subpulmonic intramyocardial course – a case report

Surgery for anomalous aortic origin of coronary arteries: a multicentre study from the European Congenital Heart Surgeons Association†

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