Review Article| Volume 26, P63-74, 2023

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Toward More Granular Guidelines in AAOCA: Associating Anatomical Details With Specific Surgical Strategies

  • Anusha Jegatheeswaran
    Address correspondence to: Anusha Jegatheeswaran MD, PhD, FRCSC, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, United Kingdom.
    Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London

    Children's Cardiovascular Disease, Institute of Cardiovascular Sciences, University College London, London
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  • William M. DeCampli
    Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida

    Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, Florida
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Published:February 02, 2023DOI:
      Patients with anomalous aortic origin of a coronary artery (AAOCA) require imaging to clarify the multiple potential anatomic sites of obstruction (fixed or dynamic). Once repaired, the pathway of blood to the myocardium must not encounter: (1) intrinsic ostial stenosis, (2) obstruction from compression or distortion near the commissure or the intercoronary pillar, (3) stenosis where the artery exits the aortic wall (due to an acutely angled “take-off”), (4) compression due to a pathway between the great vessels, (5) stenosis or compression along an intramural course, or (6) compression due to an intramuscular (intraseptal/intraconal) course. Detailed anatomic evaluation of each of these locations allows the surgeon to select an appropriate repair strategy, and each of these abnormal anatomic features should be “matched” with a particular surgical correction. We speculate that the most common surgical repair, unroofing with or without tacking, is often inadequate, as in isolation, it may not allow for correction with a large orifice from the appropriate sinus, without an interarterial course. While the evidence base is insufficient to call these recommendations formal guidelines, these recommendations should serve as a basis for further validity testing, and ultimate evolution to more granular guidelines on AAOCA management.


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