Patch angioplasty and neo-ostium creation for intramural left coronary artery

Ito, Hisato; Takabayashi, Shin; Kajimoto, Masaki; Shimpo, Hideto

doi:10.1510/icvts.2011.278531

Cited by 5 publications

(1 citation statement)

References 9 publications

(13 reference statements)

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“…To eliminate the stenosis, such an intramural segment needs to be trimmed or patched, 11 and either approach involves delicate techniques. Stent implantation, tested successfully in R-ACAOS, is theoretically also a primary alternative to surgery; however, it is generally considered …”

Section: Discussionmentioning

confidence: 99%

Sudden Cardiac Arrest at the Finish Line: In Coronary Ectopia, the Cause of Ischemia Is from Intramural Course, Not Ostial Location

Joggerst¹,

Monge²,

Uribe³

et al. 2014

Texas Heart Institute Journal

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C ongenital coronary artery anomalies (CCAs) are important causes of sudden cardiac arrest (SCA).1-3 We report the case of a patient in whom the mode and pathophysiology of SCA were documented to a thorough degree. The details of this case add to our knowledge of CCAs and the mechanisms of SCA in young athletes who have these rare conditions. Case ReportA 26-year-old woman, a well-trained and accomplished runner (body mass index, 16.7 kg/m 2 ), collapsed 200 meters from the finish line of a 26.2-mile marathon after running for 3 hours 27 minutes. She was rushed to a nearby medical tent and was found to be pulseless. A rhythm strip revealed ventricular fibrillation. After undergoing brief chest compressions, she was given 1 mg of intravenous epinephrine followed by 2 direct-current cardioversions. Sinus rhythm was restored, and a pulse was palpable.The patient was intubated and transported to a nearby hospital, where a 12-lead electrocardiogram showed sinus tachycardia with inferolateral ST-segment depression. She was rushed to our tertiary center. A peak troponin I level of 1.88 ng/mL and a creatine kinase level of 6,426 U/L were noted. Thirty-six hours after the SCA and after hypothermia was discontinued, she made a full neurologic recovery. She was soon weaned from mechanical ventilation.On day 6 after the SCA, echocardiograms showed normal left ventricular (LV) wall thickness and motion. Cardiac magnetic resonance images revealed that the left main coronary artery (LMCA) originated ectopically from the right coronary sinus (Fig. 1) and that the proximal left main (LM) trunk probably had an intramural course, inside the aortic wall. The LMCA ran between the aorta and pulmonary artery (pursuing an interarterial or "preaortic" course) before branching into the left anterior descending coronary artery (LAD) and left circumflex coronary artery. A viability study showed only small focal areas of intramural hyperenhancement, suggesting a small scar, at the mid-anteroseptal LV wall. On day 9, coronary angiograms revealed an anoma-

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Section: Discussionmentioning

confidence: 99%

Sudden Cardiac Arrest at the Finish Line: In Coronary Ectopia, the Cause of Ischemia Is from Intramural Course, Not Ostial Location

Joggerst¹,

Monge²,

Uribe³

et al. 2014

Texas Heart Institute Journal

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Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course

et al. 2012

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Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised.

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Successful neo-ostium creation using pulmonary artery tissue in a case of anomalous origin of the left coronary artery from the right sinus of Valsalva

Kumagai¹,

Kin²,

Ikai³

et al. 2014

Interact CardioVasc Thorac Surg

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Anomalous origin of the left coronary artery (LCA) from the right sinus of Valsalva is rare and is known to cause sudden death in young patients. A 17-year old male patient experienced syncopal episodes after intense exercise. No abnormal findings were noted on brain magnetic resonance imaging, electroencephalography or Holter monitoring. Contrast-enhanced coronary computed tomography revealed the anomalous origin of the LCA from the right sinus of Valsalva. Considering the positional relationship with the aortic valve and the morphology of the left main trunk, a neo-ostium was created in the left coronary sinus, and patch angioplasty was performed using pulmonary arterial wall tissue. The postoperative course of the patient was uneventful, and the patient remains asymptomatic 2 years after surgery. Here, we describe this case and review the literature on the different surgical techniques for this anomaly. We believe that our technique would be useful in cases of anomalous origin of the LCA from the right sinus of Valsalva, regardless of morphological variations.

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Patch angioplasty and neo-ostium creation for intramural left coronary artery

Cited by 5 publications

References 9 publications

Sudden Cardiac Arrest at the Finish Line: In Coronary Ectopia, the Cause of Ischemia Is from Intramural Course, Not Ostial Location

Sudden Cardiac Arrest at the Finish Line: In Coronary Ectopia, the Cause of Ischemia Is from Intramural Course, Not Ostial Location

Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course

Successful neo-ostium creation using pulmonary artery tissue in a case of anomalous origin of the left coronary artery from the right sinus of Valsalva

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