Surgical strategies for anomalous origin of the left coronary artery from the right pulmonary artery with an intramural aortic course: A report of 10 cases

Abstract

Careful attention should be paid to the extremely rare association of an aortic intramural course before and during an operation when dealing with anomalous LCA from the RPA. Surgical strategies for aortic reimplantation include coronary button transfer and unroofing of the intramural segment. The outcomes are encouraging.

A curious course of an intramural anomalous left coronary artery from the pulmonary artery

“…11 Furthermore, our experience was similar to that of others. [4][5][6][7][8] The patients studied by Zhang and colleagues 10 were older at the time of repair compared with most modern reports, which likely explains a higher proportion of children with left ventricular aneurysms and relatively high mortality. The surgical technique of coronary artery transfer and unroofing appears to provide reliable reperfusion of the myocardium and resulted in improvement of the left ventricular function.…”

“…As long as the coronary artery is not allowed to kink during reimplantation, the unroofing is easy and likely to be the best option. 4 The technique described by Zhang and colleagues 10 is a valuable addition to armamentarium of any cardiothoracic surgeon who deals with congenital coronary anomalies.…”

Intramural Aortic Course Should Always Be Considered for Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery

“…We have previously described association of intramural course with anomalous origin of right coronary from PA. 3 Similarly, intramural course of the LCA within the aorta has been described with ALCARPA. [4][5][6][7][8] We have summarized cases reported in the literature in Table 1. Ogden 14 proposed a theory of dual origin: the distal arteries develop first as a vascular network in the atrioventricular and interventricular grooves to form a peritruncal ring around the great vessels and the proximal portions then appear as angioblastic buds that grow out to anastomose with the distal network.…”

Surgical outcomes for anomalous left coronary artery from the pulmonary artery: Influence of late presentation

“…[3][4][5][6][7] However, the surgical outcomes remain suboptimal in Chinese populations, even in tertiary cardiac centers. [8][9][10] Although surgery is indicated as soon as the diagnosis is made, late referral is not uncommon in China, 11 as is the case in other congenital heart disease. [12][13][14] Therefore we sought to review the surgical management of ALCAPA in our center, identify the risk factors for early mortality, and evaluate the midterm outcomes.…”