Anomalous Aortic Origin of Coronary Arteries: Case Report of Unroofing With Coronary Re-Implantation Technique

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Anomalous aortic origin of the right coronary artery from the left sinus of Valsalva (Type III, inter-arterial) (n=1). Intervention: Surgical unroofing with coronary ostium expansion and re-implantation. Primary outcome: Clinical symptom resolution and NYHA functional class.

Q: What does this research mean for the field?

Surgical unroofing with coronary re-implantation provides effective symptom relief and favorable midterm outcomes in anomalous aortic origin of the right coronary artery, including after failed coronary artery bypass grafting. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Carlos Riera Kinkel; David Roldan-Morales; Martín Rosas-Peralta; Gabriela Borrayo–Sánchez; Alberto Ramírez-Castañeda; Luis Antonio Moreno-Ruíz; Yatsil Necoechea-Osuna; Erick Ramírez-Árias; Alberto Lopez-Gutierrez; Jaime Salgado-Vázquez; Sebastián Izunza Saldaña; Horacio Márquez-González; Lucelli Yáñez‐Gutiérrez; Guillermo Saturno-Chiu

doi:10.15226/2573-864x/4/2/00157

April 19, 2019American Journal of Cardiovascular and Thoracic SurgeryOpen Access

Anomalous Aortic Origin of Coronary Arteries: Case Report of Unroofing With Coronary Re-Implantation Technique

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Key result

Surgical unroofing with coronary re-implantation achieves full symptom resolution at 6 months post-CABG failure.

n=1

Why the study?

Anomalous aortic origin of the coronary arteries is an uncommon but occasionally lethal disorder where the possibility of sudden death indicates surgical correction, particularly after occlusion of a previous coronary bypass graft.

Key Points

To describe the surgical management of an anomalous aortic origin of the right coronary artery originating from the left sinus of Valsalva following an occluded previous bypass graft.
Case report of a 55-year-old female presenting with NYHA class III dyspnea, fatigue, syncope, and inferior wall ischemia six years after coronary artery bypass grafting (CABG) with an internal mammary artery.
Computed tomography angiography confirmed occlusion of the previous bypass graft.
Surgical correction was executed by expanding and reinserting the right coronary artery ostium into the aortic wall, followed by unroofing of the intramural inter-arterial segment to relieve acute angulation.
The unroofing and reimplantation procedure was performed without any complications.
The patient was discharged in NYHA functional class I and remained asymptomatic at 6 months of follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female patient (age 55) in Mexico with anomalous aortic origin of the right coronary artery from the left sinus of Valsalva (Type III), NYHA class III dyspnea, syncope, severe inferior ischemia, and occluded prior CABG, followed for 6 months.

I

Intervention

Surgical unroofing of the intramural/inter-arterial segment of the right coronary artery with ostial expansion and re-implantation into the aortic wall.

O

Outcome

Symptom resolution and NYHA functional class at discharge and 6 months follow-uppatient reported

Demonstrates that surgical unroofing with coronary re-implantation can successfully restore normal anatomy and resolve ischemia in patients with anomalous aortic origin of the right coronary artery after prior CABG occlusion.

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Implication

Supports feasibility of unroofing plus reimplantation after CABG failure; leaves open validation in larger series before wider use.

Abstract

Anomalous Aortic Origin of Coronary Arteries is a coronary disorder uncommon but occasionally lethal.The possibility of sudden death is the indication for surgery.We inform a case of a patient with anomalous aortic origin of right coronary artery which emerged from left sinus of Valsalva, catalogued as type III.He was previously treated by CBAG, however the bypass was occluded and therefore he was sent to our service.We made a correction using the unroofing technique.Unroofing technique is a reproducible technique with good results, ultimately solving the problem.The outcome was excellent, 6 months later he was reported asymptomatic.

Discussion

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Cite This Study

Kinkel et al. (2019) conducted a case report in Anomalous aortic origin of the right coronary artery from the left sinus of Valsalva (Type III, inter-arterial) (n=1). Surgical unroofing with coronary ostium expansion and re-implantation was evaluated on Clinical symptom resolution and NYHA functional class. Surgical unroofing with coronary re-implantation in a 55-year-old female with occluded prior CABG resulted in discharge at functional class I and asymptomatic status at 6 months.

synapsesocial.com/papers/6af74bcb3619df6681bc3869 https://doi.org/10.15226/2573-864x/4/2/00157

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Anomalous Aortic Origin of Coronary Arteries: Case Report of Unroofing With Coronary Re-Implantation Technique

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Anomalous Aortic Origin of Coronary Arteries: Case Report of Unroofing With Coronary Re-Implantation Technique

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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