Surgical treatment of anomalous left main coronary artery with an intraconal course

Abstract

Objective Anomalous left main coronary artery (LMCA) with an intraconal course is a relatively rare form of anomalous aortic origin of a coronary artery (AAOCA) from the wrong sinus of Valsalva. There is currently a paucity of information regarding this entity. The purpose of this article is to review our surgical experience with repair of anomalous LMCA with an intraconal course. Methods This was a retrospective review of 12 patients with an anomalous LMCA and an intraconal course who underwent surgical repair. The median age at surgery was 15 years (range 2‐47). The seven oldest patients all had preoperative symptoms of exertional chest pain and one also had exertional syncope. The five youngest patients had no preoperative symptoms. One of these patients had a hemodynamically significant ventricular septal defect and one patient was the sibling of a patient who had undergone repair of AAOCA. Results The 12 patients underwent surgical repair including unroofing of the myocardial bridge overlying the intraconal LMCA and a LeCompte procedure. There was no early or late mortality and there were no significant complications. All 12 patients have resumed normal, unrestricted activities. Conclusions Twelve patients with an anomalous LMCA and intraconal course presented to our institution for treatment. Surgical repair was performed successfully in all 12, with resolution of symptoms in the 7 patients who were symptomatic preoperatively. These results suggest that the surgical treatment is safe and efficacious in patients with an anomalous LMCA and intraconal course.

Pulmonary Root Mobilization and Modified Lecompte Maneuver for Transseptal Course of the Left Main Coronary Artery

“…Mainwaring and Hanley described a similar technique in 12 patients with excellent results and resolution of symptoms in all patients. 6 As described in their report, they relied upon division of the right branch PA to provide access to the intraconal LMCA. We feel that the addition of transection and caudal retraction of the main PA and transaortic placement of a probe within the LMCA to provide guidance with respect to the coronary artery's location and course relative to the pulmonary root are also helpful.…”

Therapeutic Management of Anomalous Coronary Arteries Originating From the Opposite Sinus of Valsalva: Current Evidence, Proposed Approach, and the Unknowing

“…Alternatively, pulmonary artery translocation can be performed by moving the pulmonary arteries anterior to the aorta (modified LeCompte maneuver). 58 , 109 , 110 , 111 Both procedures result in the creation of additional space between the great arteries, 112 addressing the historically believed compression of the anomalous segment between the great arteries. However, this mechanism is unlikely considering the pressure condition in the respective circulatory systems.…”