Coronary Artery Anomalies in Common Arterial Trunk: Proposal of a New Anatomical Classification

Coronary artery abnormalities (CAAs) are frequently encountered in common arterial trunk (CAT), with an estimated incidence of 5%-20%. However, their prognostic implications remain unclear. Surgical challenges potentially arise due to coronary arteries crossing the right ventricular outflow tract (RVOT), close proximity of the coronary and pulmonary orifices, and distortion to the proximal coronary segments and ostia during arch reconstruction or truncal valve replacement. Some studies have demonstrated that CAAs confer worse outcomes after CAT repair, while others have reported no significant prognostic impact. Both the number and subtype of CAAs may influence outcomes, but heterogeneous categorization limits the conclusions that can be drawn from existing studies. A uniform classification of CAAs in CAT is warranted to better ascertain the prognostic impact of CAA burden and morphology. This may enable more focused decision-making in clinical scenarios where a high-risk CAA pattern is suspected. For example, it may help inform the intraoperative trade-off between probing the coronaries to define their precise morphology against the risk of causing damage. We propose a classification consisting of 6 abnormalities: (1) single coronary artery, (2) ostial stenosis, (3) intramural course, (4) juxtacommissural origin, (5) coronary crossing RVOT, and (6) close proximity of coronary and pulmonary orifices.