Anomalous aortic origin of a coronary artery (AAOCA) can be associated with myocardial
ischemia and sudden cardiac arrest. We describe and compare the management and surgical
techniques for patients with AAOCA. Patients presenting to the Coronary Artery Anomalies
Program are evaluated and managed following a standardized approach. Our approach
and data were compared to other single-center and multi-institutional data and results.
Patients with AAOCA present as an incidental finding approximately 50% of the time.
Advanced axial imaging is essential to define the anatomic characteristics of this
lesion. Preoperative and postoperative assessment of myocardial perfusion with provocative
testing is feasible and contributes to risk stratification. The surgical techniques
for AAOCA repair include coronary unroofing, transection and reimplantation, and neo-ostium
creation, among others. In general, surgical repair of AAOCA can mitigate the risk
of ischemia with low mortality. The specific morbidities and complications of each
different technique should be considered during the surgical planning. Surgical repair
of AAOCA can mitigate the risk of ischemia with a low associated mortality but with
clinically relevant morbidities. Long-term follow-up is necessary to accurately balance
the risks of repaired and unrepaired AAOCA.
Keywords
Glossary:
AAOCA (Anomalous aortic origin of a coronary artery), SCA (Sudden cardiac arrest), IM (Intramural), TAR (Transection and reimplantation), CAAP (Coronary artery anomalies program), CTA (Computed tomography angiography), sNPI (stress nuclear perfusion imaging), sCMR (Stress cardiac magnetic resonance imaging), AAORCA (Anomalous aortic origin of the right coronary artery), AAOLCA (Anomalous aortic origin of the left coronary artery)To read this article in full you will need to make a payment
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