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Updated: Aug 31, 2025

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
13:10

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

18.7K

Coronary unroofing does not fits all anomalous aortic origin of coronary arteries

Luigi Arcieri1, Massimo Colaneri1, Francesco Bianco1

  • 1Pediatric Cardiology and Cardiac Surgery Unit, Ospedali Riuniti Ancona, Ancona, Italy.

Journal of Cardiac Surgery
|August 22, 2022
PubMed

Insights

Anomalous aortic origin of coronary artery (AAOCA) surgery, when tailored to individual anatomy, effectively resolves symptoms and prevents recurrence. This patient-centered approach ensures young athletes can return to competitive sports safely.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Anomalous aortic origin of coronary artery (AAOCA) is a significant cause of sudden cardiac death in young individuals.
  • The intramural-interarterial course is the most common anatomical variation, often managed with coronary unroofing.
  • Symptom recurrence is a known issue despite current surgical interventions.

Purpose of the Study:

  • To evaluate an anatomic, patient-centered surgical approach for AAOCA.
  • To assess the association between restoring normal coronary artery take-off and symptom resolution.
  • To analyze surgical outcomes in a cohort of patients with AAOCA.

Main Methods:

  • Retrospective analysis of 25 patients operated on for AAOCA between 2008 and 2021.
  • Detailed review of patient demographics, anatomical variations (right/left AAOCA, intramural course), and presenting symptoms.
  • Surgical techniques included coronary unroofing, neo-ostioplasty, reimplantation, and main pulmonary artery relocation, chosen based on individual anatomy.

Main Results:

  • No hospital mortality or reoperations were recorded; major surgical complications were absent.
  • Mean hospital stay was 8.5 days, with no reported symptom recurrence during follow-up.
  • Postoperative imaging confirmed improved coronary take-off angles, enabling return to competitive sports for young athletes.

Conclusions:

  • AAOCA management necessitates individualized surgical strategies based on patient anatomy.
  • A tailored approach, selecting techniques based on preoperative and intraoperative findings, is crucial.
  • This patient-specific policy demonstrated success in achieving symptom resolution and preventing recurrence.
Abstract

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