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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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Transcatheter aortic valve replacement in patients with anomalous left circumflex coronary artery

Kosuke Ujihira1, Amish N Raval2, Matthew R Wolff2

  • 1Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Journal of Cardiac Surgery
|April 26, 2019
PubMed

Insights

An anomalous left circumflex artery poses risks during transcatheter aortic valve replacement. Protecting the artery with a guidewire and balloon proved safe, similar to unprotected procedures, in three patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Anomalous left circumflex artery (ALCA) is a rare coronary anomaly.
  • ALCA can increase risks of coronary artery stenosis or obstruction during transcatheter aortic valve replacement (TAVR).
  • Optimal procedural management for ALCA during TAVR remains unclear.

Observation:

  • This report details three cases of severe aortic stenosis with an ALCX.
  • In one case, a coronary guidewire and balloon were used for protection before TAVR.
  • In the other two cases, TAVR was performed without specific coronary protection measures.

Findings:

  • All three TAVR procedures were successfully completed without immediate complications.
  • No coronary stenosis or obstruction occurred during or after the procedures.
  • One-year follow-up revealed no adverse events in any of the patients.

Implications:

  • The findings suggest that TAVR can be performed safely in patients with ALCX, even without routine coronary protection.
  • Further research is needed to definitively establish the best procedural management for ALCX during TAVR.
  • These cases contribute to the understanding of managing complex coronary anatomy during TAVR.

Keywords:
anomalous left circumflex arteryaortic valve stenosistranscatheter aortic valve replacement

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