Anomalous coronary arteries coursing between the aorta and pulmonary trunk: clinical indications for coronary artery bypass

Abstract

Coronary arteries of anomalous origin with subsequent coursing between the aorta and pulmonary trunk can cause ischaemia, infarction or sudden death. However, reports of surgical correction are sparse due to the rarity of ante-mortem diagnosis. We report two cases in which symptoms were related to anomalous origin of a non-atherosclerotic coronary artery. Surgical repair was performed to prevent sudden death or recurrent ischaemia.

Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: Multicenter data collection

“…This distinction has prognostic value. Depending on the clinical scenario, such patients often undergo the coronary artery surgery [28]. Recently, noninvasive imaging techniques such as multidetectorrow computed tomography (MDCT), magnetic resonance imaging, and electron beam tomography have been shown to provide a good anatomical view of the coronary tree.…”

Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus: Case report

“…6,7 Other techniques such as coronary artery bypass grafting using a saphenous vein or ipsilateral internal mammary artery have been proposed; however, they may be more suitable for older patients with associated atherosclerotic changes. 9 Performing this type of surgery on younger patients, such as in the present case, may be counterintuitive because the long-term patency of the graft has not been established and the graft may theoretically compete with the normal antegrade flow of the anomalous artery, leading to concerns of graft thrombosis. 9 Instead, a coronary reimplantation can be considered in which the anomalous coronary artery is ligated and transected proximally and anastomosed in the correct sinus of Valsalva.…”

“…6 The surgical method of correcting such anomalies remains controversial, with many techniques recommended over the years, including a coronary artery bypass, coronary reimplantation and unroofing of the intramural segment. [7][8][9][10] In 1981, Mustafa et al first described the use of an unroofing procedure to correct an anomalous left coronary artery anomaly. 7 This technique has since become the procedure of preference for many surgeons, especially if the course of the anomalous coronary artery is intramural.…”

Fehlabgang der linken aus der rechten Koronararterie

“…Diese werden durch Kompression der linken Koronararterie zwischen der Pulmonalarterie und der Aorta ascendens, ein "Kinking", einem temporären Verschluss des spitzwinklig angelegten Ostiums oder eine erhöhte Spasmusneigung der linken Koronararterie verursacht [2,8]. Nicht selten ist der plötzliche Herztod, der durch eine diffuse myokardiale Infarzierung und die körperliche Belastung (in der Regel junger und sportlicher Männer) getriggert wird, die Erstmanifestation dieser Erkrankung [8,9]. Weder das 12-Kanal-noch das Belastungs-EKG tragen zuverlässig zu deren Diagnostik bei [2].…”

“…0,05% sehr selten [9]. Die korrekte Diagnose dieses Krankheitsbildes wird oft erst bei der Autopsie gestellt, da es bei entsprechender Symptomatik der Patienten (Angina pectoris, Herzrhythmusstörungen, Synkopen, plötzlicher Herztod) oft nicht mit in die Differentialdiagnose einbezogen wird und außerdem mit den Routineuntersuchungen zumeist nicht festgestellt werden kann [2].…”