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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 in Children: Postoperative High-risk Anatomic Features

Tam T Doan1, Shagun Sachdeva1, Carlos Bonilla-Ramirez2

  • 1Coronary Artery Anomalies Program, Section of Cardiology, Texas Children's Hospital, Houston, Texas.

The Annals of Thoracic Surgery
|December 5, 2022
PubMed

Insights

Surgical unroofing for anomalous aortic origin of a coronary artery (AAOCA) often leaves residual high-risk anatomic features (HRAFs), unlike transection and reimplantation (TAR). Long-term outcomes of these residual features require further investigation.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Medical Imaging

Background:

  • Anomalous aortic origin of a coronary artery (AAOCA) can present with high-risk anatomic features (HRAFs).
  • Surgical repair aims to correct these anomalies, but residual features may persist.
  • Computed tomographic angiography (CTA) is used to assess postoperative anatomy.

Purpose of the Study:

  • To evaluate postoperative HRAFs after surgical unroofing versus transection and reimplantation (TAR) for AAOCA.
  • To compare the effectiveness of unroofing and TAR in resolving HRAFs.
  • To identify potential predictors of residual HRAFs.

Main Methods:

  • Retrospective analysis of 62 children with AAOCA who underwent postoperative CTA.
  • Comparison of HRAFs (slitlike ostium, intramural course, acute angle takeoff, interarterial course, stenosis, thickened intercoronary pillar) between unroofing (n=45) and TAR (n=17) groups.
  • Correlation of preoperative factors with postoperative HRAFs.

Main Results:

  • Slitlike ostium and intramural course resolved in all patients postoperatively.
  • Acute takeoff persisted in 100% after unroofing vs 12% after TAR (P < .001).
  • Improved but residual interarterial course (78%) and thickened intercoronary pillar (22%) were common after unroofing, unlike TAR. Severe stenosis requiring revision occurred only after TAR.

Conclusions:

  • Surgical unroofing for AAOCA frequently results in residual HRAFs, including acute takeoff and interarterial course.
  • Transection and reimplantation (TAR) resolves HRAFs more effectively but carries a risk of severe stenosis.
  • The long-term clinical significance of residual HRAFs after unroofing warrants further study.
Abstract

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