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Nelson Alphonso
Petros V. Anagnostopoulos
Lars Nölke
Anthony Azakie
Gary W. Raff
Tom R. Karl
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Ann Thorac Surg 2007;83:1472-1476
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Anomalous Coronary Artery From the Wrong Sinus of Valsalva: A Physiologic Repair Strategy

Nelson Alphonso, MD, Petros V. Anagnostopoulos, MD, Lars Nölke, MD, Anita Moon-Grady, MD, Anthony Azakie, MD, Gary W. Raff, MD, Tom R. Karl, MD*

Pediatric Heart Center, UCSF Children’s Hospital, University of California San Francisco, San Francisco, California

Accepted for publication October 24, 2006.

* Address correspondence to Dr Karl, UCSF Division of Pediatric Cardiothoracic Surgery, 513 Parnassus Ave, Suite S-549, Box 0117, San Francisco, CA 94143-0117 (Email: karlt{at}surgery.ucsf.edu).

Background: A coronary artery arising from the wrong aortic sinus, with or without a proximal course between the aorta and the pulmonary artery, may predispose to myocardial ischemia, myocardial infarction, or sudden death.

Methods: We repaired this lesion in 5 symptomatic patients, all of whom had experienced exercise-related chest pain, dyspnea, or syncopal episodes. All patients underwent patch angioplasty of the proximal anomalous coronary artery with glutaraldehyde-treated autologous pericardium. When the coronary artery coursed between the aorta and the main pulmonary artery, the main pulmonary artery was translocated toward the left pulmonary artery to create additional space and prevent compression.

Results: All patients recovered well and to date have demonstrated no evidence of recurrent myocardial ischemia.

Conclusions: The combination of coronary artery angioplasty and translocation of the pulmonary artery seems to effectively address all the mechanisms that can generate ischemia.






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Copyright © 2007 by The Society of Thoracic Surgeons.