Surgical treatment of right coronary arteries with anomalous origin and slit ostium
Raúl García-Rinaldi1, Javier Sosa, Samuel Olmeda
1Division of Cardiovascular Surgery, Advanced Cardiology Center, Mayagüez, Puerto Rico. garciarinaldi@prtc.net
Insights
Anomalous origin of the right coronary artery can cause myocardial ischemia. Transaortic unroofing effectively addresses this congenital heart defect, leading to excellent patient outcomes and symptom relief.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Anomalous origin of the right coronary artery (ARCA) from the left or anterior sinus with a slit ostium is a rare condition.
- This malformation can lead to systolic compression within the aorta, causing myocardial ischemia, angina, and potentially sudden death.
Purpose of the Study:
- To evaluate the efficacy of transaortic unroofing for ARCA with slit ostium.
- To assess the long-term outcomes and safety of this surgical intervention.
Main Methods:
- A retrospective review of 20 patients (16 with ARCA from left sinus, 4 from anterior sinus) treated between 1991 and 2003.
- All patients underwent transaortic unroofing to modify the proximal portion of the anomalous coronary artery.
Main Results:
- All patients survived the surgery; one late death occurred from unrelated causes.
- Follow-up (0.2-11.8 years) showed 19 patients remained asymptomatic (New York Heart Association class I).
- One patient developed angina post-surgery, treated successfully with percutaneous transluminal coronary angioplasty (PTCA).
Conclusions:
- Transaortic unroofing is a safe and effective surgical treatment for ARCA with slit ostium.
- This approach successfully addresses the underlying anatomical and pathophysiological issues, preventing myocardial ischemia.
- Excellent long-term results, including symptom resolution and absence of major adverse cardiac events, can be achieved.
Background:
Right coronary arteries arising in the left sinus or ectopically in the anterior coronary sinus with slit ostium course inside the aorta. They are subject to variable systolic compression and can cause myocardial ischemia with its sequelae or death.
Methods:
From May 1991 to March 2003, we treated 16 patients with anomalous origin of the right coronary artery from the left sinus and 4 whose right coronary artery arose ectopically in the anterior sinus. All patients had a slit ostium and underwent transaortic unroofing of the trunk to modify the proximal portion of the anomalous artery.
Results:
All patients survived operation, although 1 patient died of unrelated causes. Nineteen patients were followed for a period from 0.2 to 11.8 years (median age, 53 years). One experienced angina 1 year after surgery and underwent percutaneous transluminal coronary angioplasty of a left internal thoracic to left anterior descending coronary artery anastomosis. All patients are New York Heart Association class I, without angina; none has sustained a myocardial infarction or required reoperation.
Conclusions:
Right coronary arteries that arise in anomalous fashion with a slit ostium can cause myocardial ischemia or death. Transaortic modification of the anomalous trunk addresses the anatomic and pathophysiologic features of the malformation that cause myocardial ischemia. Excellent results can be achieved with this surgical approach.
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