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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 the Right Coronary Artery in Adults: Surgical Reimplantation With Intermediate-Term

Dina Sabha1,2, Mohammad Alomari3,2, Laith Hyasat4

  • 1Department of Pharmacy, University of Leipzig, Leipzig, Germany.

World Journal for Pediatric & Congenital Heart Surgery
|June 11, 2026
PubMed

Insights

Surgical correction of anomalous aortic origin of the right coronary artery (AAORCA) by reimplanting the RCA into the right sinus of Valsalva shows excellent outcomes. This procedure in adults effectively resolves symptoms and maintains coronary artery patency with low mortality.

Area of Science:

  • Cardiovascular Surgery
  • Congenital Heart Disease
  • Interventional Cardiology

Background:

  • Anomalous aortic origin of the right coronary artery (AAORCA) is a rare congenital heart defect.
  • AAORCA, particularly with an intramural course, poses a risk of exertional ischemia and sudden cardiac death.
  • Surgical intervention is crucial for mitigating the risks associated with AAORCA.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of surgical RCA reimplantation for AAORCA in adult patients.
  • To assess the long-term results, including symptom resolution and coronary artery patency, following the procedure.

Main Methods:

  • Retrospective review of symptomatic adult patients undergoing RCA reimplantation for AAORCA from June 2017 to August 2024.
  • Data collection included baseline characteristics, perioperative outcomes, and follow-up assessments.
  • Coronary computed tomography angiography (CCTA) was utilized for diagnosis; RCA reimplantation into the right sinus of Valsalva was performed.

Main Results:

  • Forty adult patients (85% male, median age 44) were analyzed, with exertional chest pain being the most common symptom.
  • No in-hospital or follow-up mortality was observed.
  • At a mean follow-up of 30.3 months, 20% of patients reported recurrent symptoms; however, surveillance imaging confirmed widely patent RCA without stenosis or kinking.

Conclusions:

  • RCA reimplantation into the right sinus of Valsalva is a safe and effective treatment for adults with AAORCA.
  • The procedure demonstrates excellent early- to midterm outcomes, characterized by low mortality, symptom resolution, and durable coronary patency.
  • This surgical approach successfully addresses the ischemic mechanisms associated with AAORCA.

Keywords:
anomalous aortic origin of the right coronary arterycongenital coronary anomalycoronary reimplantationinterarterial coursesurgical outcomes

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