Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T06:04:14.970Z Has data issue: false hasContentIssue false
  • English
  • Français

Anomalous aortic origin of a coronary artery: a universally applicable surgical strategy

Published online by Cambridge University Press:  01 December 2010

Tom R. Karl ,
Sylvio C. J. Provenzano  and
Graham R. Nunn
Tom R. Karl*
Affiliation:
Department of Cardiac Surgery, Queensland Paediatric Cardiac Service, Mater Children’s Hospital, Brisbane, Australia
Sylvio C. J. Provenzano
Affiliation:
Department of Cardiac Surgery, Queensland Paediatric Cardiac Service, Mater Children’s Hospital, Brisbane, Australia
Graham R. Nunn
Affiliation:
Department of Cardiac Surgery, Queensland Paediatric Cardiac Service, Mater Children’s Hospital, Brisbane, Australia
*
Correspondence to: Professor T. R. Karl, Department of Paediatric Cardiac Surgery, Mater Children’s Hospital, Raymond Terrace, S. Brisbane QLD 4101, Australia. Tel: +61 411340036; Fax: +1 212 202 3622; E-mail: trkarl.aus@gmail.com
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Congenital cardiac diseasepaediatric cardiac diseaseinterarterial coronary arteryintramural coronary arteryintraconal coronary artery
Type
Original Article
Information
Cardiology in the Young , Volume 20 , Issue S3: Rare and Challenging Congenital Cardiac Lesions: an Interdisciplinary Approach , December 2010 , pp. 44 - 49
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cheitlin, MD, De Castro, CM, McAllister, HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva: a not so minor congenital anomaly. Circulation 1974; 50: 780–787.CrossRefGoogle Scholar
2.Angelini, P. Coronary artery anomalies: current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J 2002; 29: 271–278.Google ScholarPubMed
3.Davis, JA, Cecchin, F, Jones, TK, Portman, MA. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 2001; 37: 593–597.CrossRefGoogle Scholar
4.Liberthson, RR. Sudden death from cardiac causes in children and young adults. N Engl J Med 1996; 334: 1039–1044.CrossRefGoogle ScholarPubMed
5.Maron, BJ, Shirani, J, Poliac, LC, Mathenge, R, Roberts, WC, Mueller, FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 1996; 276: 199–204.CrossRefGoogle ScholarPubMed
6.Basso, C, Maron, BJ, Corrado, D, Thiene, G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35: 1493–1501.CrossRefGoogle ScholarPubMed
7.Basso, C, Corrado, D, Thiene, G. Congenital coronary artery anomalies as an important cause of sudden death in the young. Cardiol Rev 2001; 9: 312–317.CrossRefGoogle ScholarPubMed
8.Ono, M, Brown, DA, Wolf, RK. Two cases of anomalous origin of LAD from right coronary artery requiring coronary artery bypass. Cardiovasc Surg 2003; 11: 90–92.CrossRefGoogle ScholarPubMed
9.Garcia-Rinaldi, R. Right coronary arteries that course between aorta and pulmonary artery. Ann Thorac Surg 2002; 74: 973–974.CrossRefGoogle ScholarPubMed
10.Rodefeld, MD, Culbertson, CB, Rosenfeld, HM, Hanley, FL, Thompson, LD. Pulmonary artery translocation: a surgical option for complex anomalous coronary artery anatomy. Ann Thorac Surg 2001; 72: 2150–2152.CrossRefGoogle ScholarPubMed
11.Kitayama, H, D’Orsogna, L, Karl, TR. Isolated non-atherosclerotic coronary stenosis: surgical angioplasty of the left coronary ostium using an anterior approach. Asia Pac Heart J 1996; 5: 122–124.CrossRefGoogle Scholar
12.Patel, K, Davidson, A, Karl, TR. Anomalous left coronary artery arising from the right coronary cusp. Ann Thorac Surg 2001; 71: 2045.CrossRefGoogle ScholarPubMed
13.Alphonso, N, Anagnostopoulos, PV, Nolke, L, et al. Anomalous coronary artery from the wrong sinus of Valsalva: a physiologic repair strategy. Ann Thorac Surg 2007; 83: 1472–1476.CrossRefGoogle ScholarPubMed
14.Guy, TS, Tseng, E, Ratcliffe, MB, Azakie, A, Karl, TR. A simple correction for anomalous coronary arteries in adults. J Thorac Cardiovasc Surg 2009; 137: e50–e51.CrossRefGoogle ScholarPubMed
15.Mavroudis, C, Backer, CL, Duffy, CE, Pahl, E, Wax, DF. Pediatric coronary artery bypass for Kawasaki congenital, post arterial switch, and iatrogenic lesions. Ann Thorac Surg 1999; 68: 506–512.CrossRefGoogle ScholarPubMed
16.Di Lello, F, Mnuk, JF, Flemma, RJ, Mullen, DC. Successful coronary reimplantation for anomalous origin of the right coronary artery from the left sinus of Valsalva. J Thorac Cardiovasc Surg 1991; 102: 455–456.CrossRefGoogle ScholarPubMed
17.Anagnostopoulos, PV, Pigula, FA, Myers, JL, Beerman, LB, Siewers, RD, Gandhi, SK. Autologous patch angioplasty of the left main coronary artery in a pediatric patient: 7-year follow-up. Ann Thorac Surg 2004; 77: 1457–1459.CrossRefGoogle Scholar
18.Meseguer, J, Hurle, A, Fernandez-Latorre, F, Alonso, S, Llamas, P, Casillas, JA. Left main coronary artery patch angioplasty: midterm experience and follow-up with spiral computed tomography. Ann Thorac Surg 1998; 65: 1594–1597.CrossRefGoogle ScholarPubMed