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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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Anomalous aortic origin of coronary arteries: 'anatomical' surgical repair

Régis Gaudin1, Olivier Raisky, Pascal R Vouhé

  • 1Department of Pediatric Cardiac Surgery, Sick Children Hospital, University Paris Descartes, Sorbonne Paris Cité, Paris, France.

Multimedia Manual of Cardiothoracic Surgery : MMCTS
|March 4, 2014
PubMed

Insights

Anomalous aortic origin of coronary arteries is a rare defect with high sudden cardiac death risk. Anatomical repair is favored for high-risk cases, especially in young, active patients.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Cardiac Surgery

Background:

  • Anomalous aortic origin of coronary arteries (AAOCA) is a rare congenital defect.
  • AAOCA carries a significant risk of sudden cardiac death, particularly with specific anatomical features like an intramural course.
  • Existing surgical techniques vary, including bypass grafting and unroofing procedures.

Purpose of the Study:

  • To review the risks associated with anomalous aortic origin of coronary arteries.
  • To discuss current and favored surgical repair strategies.
  • To provide recommendations for surgical correction in symptomatic and asymptomatic patients.

Main Methods:

  • Review of existing literature on anomalous aortic origin of coronary arteries.
  • Discussion of surgical techniques, including coronary artery bypass grafting, pulmonary artery translocation, unroofing, and patch enlargement.
  • Emphasis on 'anatomical' repair involving neo-ostium creation and elimination of intramural segments.
  • Consideration of coronary artery reimplantation for specific variants.

Main Results:

  • High-risk features for sudden cardiac death include interarterial course with intramural segments, hypoplasia/stenosis, or abnormal orifice.
  • 'Anatomical' repair is favored for its effectiveness in creating a normal coronary ostium and take-off angle.
  • Reimplantation may be suitable for AAOCA variants lacking an intramural course.

Conclusions:

  • Surgical correction is essential for symptomatic patients and asymptomatic individuals with myocardial ischemia.
  • High-risk asymptomatic variants, particularly anomalous left coronary artery with intramural course in young active individuals, warrant surgical intervention.
  • Anatomical repair offers a preferred approach to mitigate risks associated with AAOCA.

Keywords:
Anomalous aortic origin of coronary arteryCongenital cardiac defectCoronary anomalySurgical correction

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