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a Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
e Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, California
b Division of Pediatric Cardiac Surgery, Oakland Children's Hospital, Oakland, California
c Division of Pediatric Cardiac Surgery, Children's Hospital of Central California, Madera, California
d Division of Pediatric Cardiac Surgery, Sutter Memorial Hospital, Sacramento, California
Accepted for publication March 9, 2011.
* Address correspondence to Dr Mainwaring, Stanford University School of Medicine, 300 Pasteur Dr, Falk CVRC, Stanford, CA 94305 (Email: mainwaring{at}stanford.edu).
Background: Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect that has been associated with myocardial ischemia and sudden death. Controversies exist regarding the diagnosis, treatment, and long-term recommendations for patients with AAOCA. The purpose of this study is to evaluate the medium-term results of surgical repair for AAOCA.
Methods: From January 1999 through August 2010, 50 patients underwent surgical repair of AAOCA. The median age at surgery was 14 years (range, 5 days to 47 years). Thirty-one patients had the right coronary originate from the left sinus of Valsalva, 17 had the left coronary originate from the right sinus, and 2 had an eccentric single coronary ostium. Twenty six of the 50 patients had symptoms of myocardial ischemia preoperatively, and 14 patients had associated congenital heart defects. Repair was accomplished by unroofing in 35, reimplantation in 6, and pulmonary artery translocation in 9.
Results: There was no operative mortality. The median time of follow-up has been 5.7 years. Two patients were lost to follow-up, and 1 patient required heart transplantation 1 year after AAOCA repair. In the remaining 47 postoperative patients, all have remained free of cardiac symptoms and no one has experienced a sudden death event.
Conclusions: The surgical treatment of AAOCA is safe and appears to be highly effective in eliminating ischemic symptoms. These medium-term results are encouraging and suggest that many patients may be able to resume normal activities.
Related Article
Ann. Thorac. Surg. 2011 92: 697.
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  J. S. Shinbane, J. Shriki, F. Fleischman, A. Hindoyan, J. Withey, C. Lee, A. Wilcox, M. Cunningham, C. Baker, R. V. Matthews, et al. Anomalous Coronary Arteries: Cardiovascular Computed Tomographic Angiography for Surgical Decisions and Planning World Journal for Pediatric and Congenital Heart Surgery, April 1, 2013; 4(2): 142 - 154. [Abstract] [Full Text] [PDF]
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 Writing Committee Members, L. D. Hillis, P. K. Smith, J. L. Anderson, J. A. Bittl, C. R. Bridges, J. G. Byrne, J. E. Cigarroa, V. J. DiSesa, L. F. Hiratzka, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 6, 2011; 124(23): e652 - e735. [Full Text] [PDF]
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 C. Pizarro Invited Commentary Ann. Thorac. Surg., August 1, 2011; 92(2): 697 - 697. [Full Text] [PDF]
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