Anomalous left circumflex artery: Implications for valve-sparing root replacement

Fukunaga, Naoto; Peterson, Mark D.

doi:10.1016/j.xjtc.2021.01.031

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Fukunaga et al also presented a case in which an ALCx was discovered intraoperatively during an aortic valve replacement. The close association of this anomaly to the aortic root required a remodeling root replacement to be performed in order to avoid injury to or compression of the ALCX [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Anomalous Left Circumflex Artery Arising From the Right Coronary Artery: A Cadaveric Case Report and Review of the Literature

Mann,

Beger

2023

Cureus

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Coronary artery anomalies are relatively rare in the general population; however, they remain clinically significant due to their varying effects on cardiovascular function and diagnostic and treatment outcomes. Here is described an anomalous left circumflex artery (ALCx) discovered during routine dissection of a 76-year-old female anatomical donor. The ALCx was seen arising from shared ostia with the right coronary artery and conus artery from the right aortic sinus of Valsalva, giving off the left atrial branch along its retroaortic course before reaching the left aspect of the coronary sulcus. The left coronary artery took a traditional course, arising from the left aortic sinus of Valsalva before traveling in the anterior interventricular sulcus. A review of the literature was conducted to determine the incidence of ALCx and elucidate any associated clinical considerations. Though relatively rare, clinical awareness is necessary as evidence indicates ALCx, particularly the retroaortic portion, may be more prone to atherosclerosis, intimal proliferation, luminal occlusion, and increased ratio of necrotic core in atherosclerotic plaques. Imaging studies, including the aortic root sign on left ventriculography, can aid in the identification of ALCx. Awareness of ALCx and its potential influence on cardiac health is critical for the avoidance of diagnostic errors and adverse treatment outcomes. Through this case report, we seek to present the current evidence outlining the incidence of ALCx, as well as the literature surrounding its clinical implications.

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Section: Discussionmentioning

confidence: 99%

Anomalous Left Circumflex Artery Arising From the Right Coronary Artery: A Cadaveric Case Report and Review of the Literature

Mann,

Beger

2023

Cureus

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“…Fukunaga and colleagues 1 present a case of a 64-year-old man with a degenerative aneurysm of his root and ascending aorta measuring 5.3 cm and 6 cm, respectively. Preoperative workup revealed an anomalous retro-aortic circumflex arising from the right coronary artery coursing in close proximity to the aortic valve annulus.…”

mentioning

confidence: 99%

Commentary: Anomalous retro-aortic circumflex artery off of the right coronary artery: Whatever works!

Venardos

Reece

2021

JTCVS Techniques

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Fukunaga and colleagues 1 present a case of a 64-year-old man with a degenerative aneurysm of his root and ascending aorta measuring 5.3 cm and 6 cm, respectively. Preoperative workup revealed an anomalous retro-aortic circumflex arising from the right coronary artery coursing in close proximity to the aortic valve annulus. This altered the operative approach such that the authors performed a root remodeling technique, sewing to the edge of the transected aorta just above the sinus rather than performing a valvesparing procedure that would have required annular or subannular stitches. They avoided any risk to the aberrant vessel. We commend the authors for using discretion and having a flexible operative strategy to deal with this unusual anatomy.Anomalous coronaries are not necessarily unusual, and this particular anomaly can be found at a frequency of 0.31% to 1.3% amongst all patients undergoing coronary angiography. 2 However, this particular anomaly is only rarely encountered during aortic valve replacement 3 or root 4 operations. Certainly compression of the circumflex artery can be an issue, and several authors have published reports on this phenomenon. [5][6][7] The options for dealing with this pesky artery include careful dissection and avoidance, mobilization and reimplantation, abandoning annular or subannular suturing (ie, changing operative

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“…In this issue of the Journal , Drs Fukunaga and Peterson report a case of an anomalous left circumflex coronary artery originating from the right coronary artery and coursing lateral and then posterior to the aorta, identified during planning for intervention on an aortic root aneurysm. 1 They successfully replaced the aorta from the root to the innominate artery, sparing the valve with a root remodeling procedure without intervention on the anomalous coronary artery (ACA). Such anatomy and pathology occur often enough to be encountered a few times during a surgical career.…”

mentioning

confidence: 99%

Commentary: Be ready to re-route your root replacement

Bozinovski

2021

JTCVS Techniques

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Anomalous left circumflex artery: Implications for valve-sparing root replacement

Abstract: Retroaortic anomalous left circumflex artery originating from the right coronary artery. CENTRAL MESSAGE Careful consideration of coronary anomalies during aortic root surgery is important in selecting the surgical approach and avoiding coronary artery injury.

Cited by 4 publications

References 9 publications

Anomalous Left Circumflex Artery Arising From the Right Coronary Artery: A Cadaveric Case Report and Review of the Literature

Anomalous Left Circumflex Artery Arising From the Right Coronary Artery: A Cadaveric Case Report and Review of the Literature

Commentary: Anomalous retro-aortic circumflex artery off of the right coronary artery: Whatever works!

Commentary: Be ready to re-route your root replacement

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