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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Published on: April 24, 2017

Anomalous aortic origin of a coronary artery: preoperative diagnosis and surgical planning

Immanuel I Turner1, Joseph W Turek, James Jaggers

  • 1Pediatric Cardiac Surgery, Duke University Medical Center, Durham, NC, USA.

World Journal for Pediatric & Congenital Heart Surgery
|June 28, 2013
PubMed

Insights

Transthoracic echocardiography (TTE) accurately diagnosed anomalous aortic origin of a coronary artery (AAOCA) in 92.5% of cases. Advanced imaging like MRI and CTA offered supplementary data but were less precise than TTE for intramural course determination.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Cardiovascular Surgery

Background:

  • Anomalous aortic origin of a coronary artery (AAOCA) involves coronary arteries arising from the wrong aortic sinus and traversing between the aorta and pulmonary artery.
  • Accurate diagnosis and characterization of AAOCA are crucial for effective surgical management.
  • Transthoracic echocardiography (TTE) has been the primary diagnostic tool, with increasing use of MRI and CTA.

Purpose of the Study:

  • To report the largest series of surgically repaired AAOCA cases.
  • To evaluate the accuracy of preoperative diagnostic studies (TTE, MRI, CTA) in characterizing AAOCA.
  • To compare the diagnostic performance of TTE, MRI, and CTA in identifying the intramural course of anomalous coronary arteries.

Main Methods:

  • A retrospective review of 53 consecutive patients who underwent surgical repair of AAOCA between 1995 and 2009.
  • Analysis of preoperative diagnostic testing results (TTE, MRI, CTA) compared against intraoperative surgical findings.
  • Assessment of diagnostic accuracy in identifying intramural versus extramural coronary artery courses.

Main Results:

  • TTE demonstrated high accuracy (92.5%) in predicting the intramural or extramural course of AAOCA.
  • MRI was accurate in 83.3% of cases, and CTA in 64.7% of cases.
  • Overall survival was 100%, with a 7.5% complication rate and high patency confirmed postoperatively.

Conclusions:

  • TTE is a highly accurate modality for defining the intramural course in AAOCA.
  • While MRI and CTA can provide valuable additional information, TTE remains superior for precise characterization of the coronary artery course in AAOCA.
  • Surgical repair of AAOCA yielded excellent long-term outcomes with high survival and graft patency rates.
Abstract

Keywords:
artery/arteriescongenital heart diseasecongenital heart surgerycoronary artery anomalycoronary artery imaging (all modalities)coronary artery surgeryechocardiography

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