Anomalous Aortic Origin of the Right Coronary Artery in Adults: Surgical Reimplantation With Intermediate-Term Results

BackgroundAnomalous aortic origin of the right coronary artery (AAORCA) with an intramural course is a rare but potentially life-threatening anomaly due to its association with exertional ischemia and sudden cardiac death. Surgical correction aims to eliminate the ischemic mechanism. This study reports a single-center experience with adult patients who underwent right coronary artery (RCA) reimplantation for AAORCA.MethodsA retrospective review was conducted of symptomatic adult patients with AAORCA who underwent RCA reimplantation between June 2017 and August 2024. Baseline clinical features, perioperative outcomes, and follow-up data were assessed.ResultsForty patients (85% [34/40] male; median age 44 years) were included. The most common presenting symptom was exertional chest pain (82.5%, [33/40]), followed by dyspnea (45%, [18/40]) and syncope or presyncope (30%, [12/40]). Coronary computed tomography angiography (CCTA) was performed to diagnose the high-risk coronary features. All patients underwent RCA reimplantation into the right sinus of Valsalva. One patient also received a saphenous-vein graft to the distal-RCA. There was no in-hospital or follow-up mortality. At a mean follow-up of 30.3 ± 20.5 months, 8/40 patients (20%) reported recurrent symptoms, including chest pain (10%, [4/40]), dyspnea on exertion (5%, [2/40]), and palpitation (5%, [2/40]). Surveillance CCTA or invasive angiography performed in 14 patients, including 8 symptomatic patients, confirmed the widely patent RCA with no ostial stenosis or kinking. Post operative exercise testing in all these patients was negative.ConclusionsIn adults with AAORCA and an intramural or interarterial course; reimplantation of the RCA into the right-sinus of Valsalva achieves excellent early- to midterm outcomes, with low mortality, symptom resolution, and durable coronary patency.