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Surgical implications of anomalous aortic origin of the left coronary artery
A O Molajo1, C L Bray, D C Beton
1Regional Cardiothoracic Centre, Wythenshawe Hospital, Manchester, England.
Insights
A patient with anomalous aortic origin of the left coronary artery experienced persistent chest pain after bypass surgery. Grafting the unstenosed left anterior descending artery improved symptoms, suggesting its role in anomalous coronary artery disease.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Anomalous aortic origin of the left coronary artery (AAOLCA) is a rare congenital heart defect.
- Patients may present with exertional chest pain (angina) due to coronary artery compression or stenosis.
- Standard coronary artery bypass grafting (CABG) may not always resolve symptoms in complex AAOLCA cases.
Observation:
- A patient with AAOLCA and stenoses in the circumflex and right coronary arteries underwent CABG.
- Despite patent grafts to these vessels, the patient continued to experience angina.
- Exercise thallium imaging revealed abnormal septal perfusion, indicating ongoing ischemia.
Findings:
- Bypass grafting of the previously unstenosed left anterior descending (LAD) coronary artery led to symptom improvement.
- This suggests the LAD, despite appearing unstenosed, was contributing to the ischemic burden in this AAOLCA patient.
- Exercise thallium imaging effectively identified the perfusion defect preoperatively.
Implications:
- The left anterior descending artery may require revascularization in select AAOLCA patients even if it appears unstenosed.
- Exercise thallium imaging can be a valuable tool for preoperative assessment in patients with anomalous coronary artery origins.
- This case highlights the importance of comprehensive evaluation and tailored surgical strategies for complex coronary anomalies.
Abstract:
We report a patient with exertional chest pain and anomalous aortic origin of the left coronary artery from the right coronary sinus. This patient also had circumflex coronary and right coronary artery stenoses. Following coronary bypass grafting of the circumflex and right coronary arteries in this patient, angina persisted and there was abnormal septal perfusion shown on the exercise thallium imaging despite patent grafts. The angina and perfusion defect were improved by bypass grafting of the unstenosed left anterior descending coronary artery in this patient. Thallium imaging may be useful in the preoperative assessment of patients with this anomaly.