Original article
Pediatric cardiac
Anomalous Aortic Origin of a Coronary Artery: Medium-Term Results After Surgical Repair in 50 Patients

https://doi.org/10.1016/j.athoracsur.2011.03.127Get rights and content

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.

Section snippets

Material and Methods

This study was submitted to the Institutional Review Board at each of the participating institutions and received separate approvals. Medical and clinic records were reviewed and a telephone survey was conducted to ascertain the patients' current health status.

This study summarizes the surgical experience with 50 patients undergoing repair of AAOCA from January 1999 through August 2010. The median age of the patients was 14 years, with a range of 5 days to 47 years. The age groups are shown in

Results

There was no operative mortality. Surgical complications occurred in 7 patients, including pleural effusions in 3, postcardiotomy syndrome in 3, and heart block in 1. The median duration of follow-up for this cohort of 50 patients was 5.7 years, with a mean of 5.3 ± 4.2 years. There were 2 patients who were lost to follow-up. The first was followed for 7 years after AAOCA repair but entered into military service and could not be located. The other patient had been followed for 2 years after

Comment

This study summarizes our experience with 50 patients who underwent surgical repair of AAOCA. There has been no operative mortality, and with an average duration follow-up of 5 and 1/2 years, there has been no late mortality. Twenty six of our patients had symptoms attributable to myocardial ischemia preoperatively, and none of these patients have had a recurrence of their symptoms during the postoperative period of surveillance. The majority of patients have resumed a normal, unrestricted

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