Anomalous Origin of Right Coronary Artery From Left Coronary Sinus-13 Cases Treated With the Reimplantation Technique
Alain Cubero1, Alejandro Crespo1, Gadah Hamzeh1
11 Division of Cardiac Surgery, Cruces University Hospital, Barakaldo, Spain.
Insights
Surgical reimplantation of anomalous right coronary artery (RCA) from the left sinus is effective. This procedure resolves symptoms and allows patients to return to exercise without limitations, with excellent midterm outcomes.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Anomalous aortic origin of a coronary artery is a rare but significant condition.
- Symptoms range from asymptomatic presentation to life-threatening events like myocardial infarction and sudden death.
Purpose of the Study:
- To describe the surgical reimplantation experience for anomalous origin of the right coronary artery (RCA) from the left aortic sinus.
- To report midterm follow-up results of this surgical technique.
Main Methods:
- Retrospective review of 13 patients who underwent surgical reimplantation of the RCA from the left sinus between 2003 and 2016.
- Diagnosis confirmed by coronary angiography or computed tomography scan.
- Surgical technique involved dissecting the RCA and reimplanting it into the right sinus of Valsalva.
Main Results:
- Mean patient age was 39 years, with presentations including dyspnea, angina, and myocardial infarction.
- All 13 patients had an intramural course of the anomalous RCA, except one interarterial course.
- No operative mortality; all patients were asymptomatic at a mean follow-up of 65 months and returned to exercise without limitations.
Conclusions:
- Surgical reimplantation is a safe and effective technique for anomalous aortic origin of the RCA.
- The procedure provides physiological and anatomical repair, preventing coronary artery compression.
- Midterm results demonstrate excellent patient outcomes and symptom resolution.
Objectives:
Anomalous aortic origin of a coronary artery is uncommon but potentially clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe our experience with surgical reimplantation and results at midterm follow-up.
Methods:
Between February 2003 and July 2016, a total of 13 patients with anomalous origin of the right coronary artery (RCA) from the left sinus underwent surgical reimplantation.
Results:
Mean age was 39 years (range, 11-72 years). Eight patients presented with dyspnea and angina, two with acute myocardial infarction, and the remaining three were studied for atypical chest pain and ventricular premature contractions. Definitive diagnosis was achieved with coronary angiography in eight cases and with computed tomography scan in five. In all cases, the anomalous origin of the RCA from the left sinus had an intramural course except one case with interarterial (but not intramural) course. At operation, the RCA was dissected at the takeoff from the intramural course and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated atherosclerotic coronary artery disease that required stent placement postoperatively. After a mean follow-up of 65 months (maximum 12 years), all patients are asymptomatic and have returned to exercise without limitations.
Conclusions:
The reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives similar results to the unroofing technique.
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