Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-26T11:58:14.681Z Has data issue: false hasContentIssue false

Repair techniques for anomalous aortic origins of the coronary arteries*

Published online by Cambridge University Press:  16 December 2015

Constantine Mavroudis*
Affiliation:
Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America Department of Surgery, Division of Cardiovascular Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, FloridaUnited States of America
Constantine D. Mavroudis
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
Jeffrey P. Jacobs
Affiliation:
Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MarylandUnited States of America Department of Surgery, Division of Cardiovascular Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, FloridaUnited States of America
*
Correspondence to: Dr C. Mavroudis, MD, Johns Hopkins Children’s Heart Surgery, Florida Hospital for Children, 2501 N Orange Ave, Suite 540, Orlando, FL 32804, United States of America. Tel: 407 303 3697; Fax: 407 303 3634; E-mail: [email protected]

Abstract

Anomalous aortic origins of the coronary arteries comprise approximately one-third of all coronary artery anomalies and are characterised by coronary arteries with anomalies of aortic origin involving abnormal courses, stenoses, and compression that can lead to myocardial ischaemia and sudden death. Operative techniques to treat these anomalies have not been standardised yet. Moreover, the management of potential complications has not been addressed. Common and rare forms of anomalous aortic origins of the coronary arteries are reviewed and understood standard techniques for an uncomplicated unroofing procedure are illustrated. Also noted are techniques that can be applied to unexpected anatomical findings and unwanted complications that could prove to be life-threatening. Several technical recommendations are offered.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at the Johns Hopkins All Children’s Heart Institute 15th Annual International Symposium on Congenital Heart Disease, Saint Petersburg, Florida, United States of America, Friday 6 February, 2015 to Monday 9 February, 2015.

References

1.Topaz, O, DeMarchena, EJ, Perin, E, Sommer, LS, Mallon, SM, Chahine, RA. Anomalous coronary arteries: angiographic findings in 80 patients. Int J Cardiol 1992; 34: 129138.CrossRefGoogle ScholarPubMed
2.Yamanaka, O, Hobbs, RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 1990; 21: 2840.CrossRefGoogle ScholarPubMed
3.Gersony, WM. Management of anomalous coronary artery from the contralateral coronary sinus. J Am Coll Cardiol 2007; 50: 20832084.CrossRefGoogle ScholarPubMed
4.Angelini, P. Coronary artery anomalies: an entity in search of an identity. Circulation 2007; 115: 12961305.CrossRefGoogle ScholarPubMed
5.Girzadas, M, Varga, P, Dajani, K. A single-center experience of detecting coronary anomalies on 64-slice computed tomography. J Cardiovasc Med (Hagerstown) 2009; 10: 842847.CrossRefGoogle ScholarPubMed
6.Miller, JA, Anavekar, NS, El Yaman, MM, Burkhart, HM, Miller, AJ, Julsrud, PR. Computed tomographic angiography identification of intramural segments in anomalous coronary arteries with interarterial course. Int J Cardiovasc Imaging 2012; 28: 15251532.CrossRefGoogle ScholarPubMed
7.Basso, C, Maron, BJ, Corrado, D, Thiene, G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35: 14931501.CrossRefGoogle ScholarPubMed
8.Davies, JE, Burkhart, HM, Dearani, JA, et al. Surgical management of anomalous aortic origin of a coronary artery. Ann Thorac Surg 2009; 88: 844847; discussion 847–848.CrossRefGoogle ScholarPubMed
9.Frommelt, PC, Frommelt, MA, Tweddell, JS, Jaquiss, RD. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol 2003; 42: 148154.CrossRefGoogle ScholarPubMed
10.Reul, RM, Cooley, DA, Hallman, GL, Reul, GJ. Surgical treatment of coronary artery anomalies: report of a 37 1/2-year experience at the Texas Heart Institute. Tex Heart Inst J 2002; 29: 299307.Google ScholarPubMed
11.Poynter, JA, Williams, WG, McIntyre, S, Brothers, JA, Jacobs, ML. Anomalous aortic origin of a coronary artery: a report from the Congenital Heart Surgeons’ Society registry. World J Pediatr Congenit Heart Surg 2014; 5: 2230.CrossRefGoogle ScholarPubMed
12.Frommelt, PC, Sheridan, DC, Berger, S, Frommelt, MA, Tweddell, JS. Ten-year experience with surgical unroofing of anomalous aortic origin of a coronary artery from the opposite sinus with an interarterial course. J Thorac Cardiovasc Surg 2011; 142: 10461051.CrossRefGoogle ScholarPubMed
13.Brothers, JA, Gaynor, JW, Jacobs, JP, Caldarone, C, Jegatheeswaran, A, Jacobs, ML. The registry of anomalous aortic origin of the coronary artery of the Congenital Heart Surgeons’ Society. Cardiol Young 2010; 20 (Suppl 3): 5058.CrossRefGoogle ScholarPubMed
14.Brothers, J, Gaynor, JW, Paridon, S, Lorber, R, Jacobs, M. Anomalous aortic origin of a coronary artery with an interarterial course: understanding current management strategies in children and young adults. Pediatr Cardiol 2009; 30: 911921.CrossRefGoogle ScholarPubMed
15.Brothers, JA, McBride, MG, Seliem, MA, et al. Evaluation of myocardial ischemia after surgical repair of anomalous aortic origin of a coronary artery in a series of pediatric patients. J Am Coll Cardiol 2007; 50: 20782082.CrossRefGoogle Scholar
16.Mavroudis, C, Backer, CL. Technical tips for three congenital heart operations: modified Ross-Konno procedure, optimal ventricular septal defect exposure by tricuspid valve incision, coronary unroofing and endarterectomy for anomalous aortic origin of the coronary artery. Oper Tech Thorac Cardiovasc Surg 2010; 15: 1840.CrossRefGoogle Scholar
17.Mumtaz, MA, Lorber, RE, Arruda, J, Pettersson, GB, Mavroudis, C. Surgery for anomalous aortic origin of the coronary artery. Ann Thorac Surg 2011; 91: 811814; discussion 814–815.CrossRefGoogle ScholarPubMed
18.Mavroudis, C, Dodge-Khatami, A, Stewart, RD, Jacobs, ML, Backer, CL, Lorber, RE. An overview of surgery options for congenital coronary artery anomalies. Fut Cardiol 2010; 6: 627645.CrossRefGoogle ScholarPubMed
19.Mainwaring, RD, Reddy, VM, Reinhartz, O, et al. Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients. Ann Thorac Surg 2011; 92: 691697.CrossRefGoogle ScholarPubMed
20.Gulati, R, Reddy, VM, Culbertson, C, et al. Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches. J Thorac Cardiovasc Surg 2007; 134: 11711178.CrossRefGoogle ScholarPubMed
21.Backer, CL, Stout, MJ, Zales, VR, et al. Anomalous origin of the left coronary artery. A twenty-year review of surgical management. J Thorac Cardiovasc Surg 1992; 103: 10491057; discussion 1057–1048.CrossRefGoogle ScholarPubMed
22.Rodefeld, MD, Culbertson, CB, Rosenfeld, HM, Hanley, FL, Thompson, LD. Pulmonary artery translocation: a surgical option for complex anomalous coronary artery anatomy. Ann Thorac Surg 2001; 72: 21502152.CrossRefGoogle ScholarPubMed
23.Turner, II, Turek, JW, Jaggers, J, Herlong, JR, Lawson, DS, Lodge, AJ. Anomalous aortic origin of a coronary artery: preoperative diagnosis and surgical planning. World J Pediatr Congenit Heart Surg 2011; 2: 340345.CrossRefGoogle ScholarPubMed
24.Guerra, VC, Recto, MR, Goldman, C, Yeh, T Jr. Anomalous aortic origin of the coronary artery: does pulmonary artery translocation affect coronary artery course? J Thorac Cardiovasc Surg 2013; 146: 15491551.CrossRefGoogle ScholarPubMed
25.Kaushal, S, Backer, CL, Popescu, AR, et al. Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery. Ann Thorac Surg 2011; 92: 986991; discussion 991–982.CrossRefGoogle ScholarPubMed
26.Poynter, JA, Jacobs, ML, Karamlou, TB, et al. Profile of current surgical techniques for repair of anomalous aortic origin of a coronary artery: a report from the Congenital Heart Surgeons’ Society AAOCA Registry. World J Pediatr Cong Heart Surg 2014; 5: 507514.CrossRefGoogle Scholar
27.Mavroudis, C, Backer, CL. (eds). Atlas of Pediatric Cardiac Surgery, 1st edn. Springer, London, 2015.CrossRefGoogle Scholar
28.Mavroudis, C, Dodge-Khatami, A, Backer, CL, Lorber, R. Coronary artery anomalies. In: Mavroudis C, Backer CL (eds). Pediatric Cardiac Surgery 4th edn, pp. 715743.Google Scholar