Surgical Treatment of Anomalous Aortic Origin of Coronary Arteries: The Reimplantation Technique and Its Modifications

Abstract

Although anomalous aortic origin of a coronary artery has been described as a benign anomaly in the past, several reports suggest that such an anomaly may be the cause of sudden death in children and younger adults. Increased cardiac output during exercise may result in compression of the anomalous coronary artery when it runs between the aorta and the pulmonary artery or when its aortic origin is narrowed and its proximal course is intramural. It is unlikely that this rare anomaly would be identified during infancy, but once diagnosis has been made, indication to proceed with surgery is controversial. Nevertheless, if surgery is recommended, several operative techniques may be used, depending on the specific anatomy; unroofing, direct reimplantation, patch enlargement, and even coronary artery bypass grafting have been proposed. In this short report, we focus on different techniques of coronary reimplantation. As we already know from the arterial switch operation in neonates and from aortic root repair or replacement in adults, sufficient mobilization is necessary to allow direct reimplantation in the correct sinus to avoid kinking and other distortion.

<p>Anomalous coronary artery anatomy with a single coronary ostium arising from the right coronary: a case report and literature review</p>

“…Left coronary artery arising from RSOV is a serious abnormality, and patients with the intra-arterial type of this anomaly are usually referred to surgery 24. Those with the other types are thought to be at low risk and do not require surgery.…”

“…In the majority of patients with a SCA or anomalous origin of a coronary artery, the native coronary artery provides adequate flow during most situations, because it is a benign lesion. Surgical correction is generally recommended for patients who have symptoms, or when this anomaly is identified in young age 24…”

Current surgical management of anomalous aortic origin of a coronary artery

“…A detailed description of the technique was recently published by Carrel. 9 A 90-degree rotation of the button may be required to avoid kinking or tension. 10,11 Alternatively, a patch ostioplasty (Figure 1, E-G) can be performed to create a new enlarged ostium as close to the native anatomic position as possible.…”

Repair of the left coronary artery originating from right coronary sinus with intramural course

“…Coronary reimplantation, coronary artery bypass grafting, unroofing, and patch ostioplasty are some different surgical techniques for the management of AAOCA. [ 12 ] Aortic insufficiency and recurrent myocardial ischemia are the most common causes of morbidity after surgical correction of AAOCA. Reimplantation technique is limited in case of the single coronary ostium and intramural course, as in our case.…”