The Anomalous Coronary Artery in Aortic Valve Replacement: A Case For Caution (original) (raw)
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Aortic Valve Replacement in 8 Adults with Anomalous Aortic Origin of Coronary Artery
Texas Heart Institute Journal
Patients with anomalous origin of a coronary artery during aortic valve replacement (AVR) are at risk of coronary compromise. Large case series are lacking. In this retrospective study, we review our experience with this condition. From August 2014 through June 2016, 8 adult patients (mean age, 74 ± 17.5 yr; age range, 33–86 yr; 5 men) with anomalous aortic origin of a coronary artery underwent surgical or transcatheter AVR at our institution. Six patients had aortic stenosis; 2 had aortic insufficiency, one of whom had an associated aortic root aneurysm. In 7 patients, the left anomalous coronary artery originated from the right aortic sinus, and in one, the right coronary artery arose from the left cusp. The anatomic course was revealed by means of 3-dimensional computed tomographic angiography. No patient underwent primary aortic reimplantation of the anomalous artery. Two had the artery mobilized from encircling the annulus too closely and then underwent coronary artery bypass g...
Srpski arhiv za celokupno lekarstvo
Introduction. Anomalous aortic origin of the right and the circumflex coronary arteries presents extremely rare and potentially dangerous combination in patients scheduled for combined coronary bypass grafting and aortic valve replacement surgery. We report this illustrative case to emphasize the importance of meticulous diagnostic setup enabling the surgeon to anticipate and avoid numerous possible pitfalls. Case outline. A 74-year-old woman, with anterior-wall myocardial infarction and aortic valve stenosis, underwent successful combined coronary artery bypass grafting and aortic valve replacement. Preoperative coronary angiography revealed unusually high take-off of the right main coronary trunk and anomalous origin and course of the circumflex coronary artery. Anatomy of both anomalous coronary arteries in the light of underlying surgical pathology necessitated a meticulous preparation and caution during successive phases of surgical treatment. Conclusion. Estimating potential p...
Patients with anomalous aortic origin of the coronary artery remain at risk after surgical repair
The Journal of Thoracic and Cardiovascular Surgery
OBJECTIVES-Anomalous aortic origin of the coronary artery(AAOCA) from the opposite sinus of Valsalva is a rare cardiac anomaly associated with sudden cardiac death(SCD). Single center studies describe surgical repair as safe, though medium and long-term effects on symptoms and risk of SCD remain unknown. We sought to describe outcomes of surgical repair of AAOCA. METHODS-We reviewed institutional records for patients who underwent AAOCA repair, 2001-2016, at two affiliated institutions. Patients with associated heart disease were excluded. RESULTS-In total, 60 patients underwent AAOCA repair. Half of patients(n=30) had an anomalous left coronary artery arising from the right sinus of Valsalva and half had an anomalous right. Median age at surgery was 15.4 years(IQR 11.9-17.9yrs;range 4mos-68yrs). Most common presenting symptoms were chest pain(n=38;63%) and shortness of breath(n=17;28%); aborted sudden cardiac death was the presenting symptom in 4(7%) patients. Follow-up data were available for 54(90%) patients over a median of 1.6years. Of 53 patients with symptoms at presentation, 34(64%) had complete resolution post-operatively. Postoperative mild or greater aortic insufficiency was present in 8(17%) patients and moderate supravalvar aortic stenosis in 1(2%). One patient required aortic valve replacement for aortic insufficiency. Two patients required reoperation for coronary stenosis at 3mos and 6years postoperatively.
Surgery for Anomalous Aortic Origin of the Coronary Artery
The Annals of Thoracic Surgery, 2011
Background. Anomalous aortic origin of the coronary artery (AAOCA) has been associated with coronary ischemia, myocardial infarction, and sudden death. Advances in echocardiography and computed tomography have identified at-risk patients. Treatment options include unroofing strategies in symptomatic and asymptomatic patients. We review our experience for efficacy and safety.
BMJ case reports, 2017
Anomalous origin of the left circumflex (Cx) artery is a common and mostly benign coronary artery anomaly. We report the case of a man aged 52 years who presented to his local hospital with progressive breathlessness on exertion and syncopal episodes. His admission transthoracic echocardiography (TTE) showed bicuspid aortic valve, severe aortic stenosis with a valve area of 0.5 cm(2) and his left ventricular ejection fraction (LVEF) was 27%. His coronary angiogram showed normal coronary arteries but anomalous origin of the Cx artery from the right coronary. He underwent elective bioprosthetic aortic valve replacement. His postoperative recovery was uneventful and he was discharged on day 5 postoperatively. His TTE postoperatively showed well-seated aortic valve, improved LVEF to 51%. We here report a case of incidental finding of anomalous Cx artery arising from the right coronary while the patient is being worked up for aortic valve replacement for congenital bicuspid aortic valve.
Clinical Features and Management of Patients with an Anomalous Origin of the Coronary Arteries
International Archives of Cardiovascular Diseases, 2018
Figure 2). Some authors have described the anomalous origin of the right coronary artery (RCA) from the left coronary sinus (66% cases) as the most frequent coronary anomaly [1,3]. However, other case series have reported an anomalous origin of the circumflex (Cx) artery from the right coronary sinus with a retro-aortic course as the more prevalent [2].
Prevalence and location of coronary artery disease in anomalous aortic origin of coronary arteries
Coronary Artery Disease, 2024
Background The prevalence and location of coronary artery disease (CAD) in anomalous aortic origin of a coronary artery (AAOCA) remain poorly documented in adults. We sought to assess the presence of CAD in proximal (or ectopic) and distal (or nonectopic) segments of AAOCA. We hypothesized that the representation of CAD may differ among the different courses of AAOCA. Methods The presence of CAD was analyzed on coronary angiography and/or coronary computed tomography angiography in 390 patients (median age 64 years; 73% male) with AAOCA included in the anomalous coronary arteries multicentric registry. Results AAOCA mainly involved circumflex artery (54.4%) and right coronary artery (RCA) (31.3%). All circumflex arteries had a retroaortic course; RCA mostly an interarterial course (98.4%). No CAD was found in the proximal segment of interarterial AAOCA, whereas 43.8% of retroaortic AAOCA, 28% of prepulmonic AAOCA and 20.8% subpulmonic AAOCA had CAD in their proximal segments (P < 0.001). CAD was more prevalent in proximal than in distal segments of retroaortic AAOCA (OR: 3.1, 95% CI: 1.8-5.4, P < 0.001). On multivariate analysis, a retroaortic course was associated with an increased prevalence of CAD in the proximal segment (adjusted OR 3.4, 95% CI: 1.3-10.7, P = 0.022). Conclusion Increased prevalence of CAD was found in the proximal segment of retroaortic AAOCA compared to the proximal segments of other AAOCA, whereas no CAD was observed in the proximal segment of interarterial AAOCA. The mechanisms underlying these differences are not yet clearly identified.
Coronary angioplasty of anomalous coronary arteries: Notes on technical aspects
Catheterization and Cardiovascular Diagnosis, 1990
Five patients with significant atherosclerotic lesions of anomalous coronary arteries underwent coronary angiopiasty of the anomalous vessel. Four patients had anomalous circumflex artery and 1 had an anomalous right coronary artery. Angiographic and clinical success was achieved in all 5 patients. To ensure adequate equipment selection special consideration should be given to angiographic characteristics of these vessels, such as the orifice configuration, exit angulation, the route the artery traverses and the location of the stenotic lesions. Major determinants for successful angioplasty in these patients are guiding catheter selection and advancement of the balloon catheter to the very proximal portion of the anomalous vessel to subsequently facilitate guide wire advance ment. This data indicates that balloon angioplasty can be successfuily utilized in patients with significant atherosclerotic disease of anomalous coronary arteries.
Anomalous Origin and Course of Coronary Artery—Presentation of Three Cases
World Journal of Cardiovascular Surgery
Anomalous origin of coronary arteries may be encountered coincidentally in the presence of unrelated pathology or when these are affected directly. This may directly be responsible for affecting the procedure or outcome. Various types of anomalies of origin, as well as course of coronary arteries, have been classified in the past. Here we report 3 cases of anomalous origin of coronary arteries in different scenarios. First case had anomalous coronary with bicuspid aortic valve with dilated ascending aorta for which Bentall's procedure was done, while the second and third cases were anomalous coronaries with coronary artery disease for which coronary artery bypass grafting was done.