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Evolution of surgical repair of intraseptal anomalous left coronary artery with myocardial ischaemia

Published online by Cambridge University Press:  02 March 2023

Alyssa B. Kalustian Open the ORCID record for Alyssa B. Kalustian [Opens in a new window] ,
Tam T. Doan ,
Prakash Masand ,
Srinath T. Gowda Open the ORCID record for Srinath T. Gowda [Opens in a new window] ,
Lindsay F. Eilers ,
Dana L. Reaves-O’Neal ,
Shagun Sachdeva ,
Athar M. Qureshi Open the ORCID record for Athar M. Qureshi [Opens in a new window] ,
Jeffrey Heinle  and
Silvana M. Molossi Open the ORCID record for Silvana M. Molossi [Opens in a new window]
...Show all authors
Alyssa B. Kalustian
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Tam T. Doan
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Prakash Masand
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Srinath T. Gowda
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Lindsay F. Eilers
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Dana L. Reaves-O’Neal
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Shagun Sachdeva
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Athar M. Qureshi
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Jeffrey Heinle
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Silvana M. Molossi
Affiliation:
Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Ziyad M. Binsalamah*
Affiliation:
Division of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: Ziyad M Binsalamah, Baylor College of Medicine and Texas Children’s Hospital, Division of Congenital Heart Surgery, 6651 Main St, Legacy Tower Heart Center, Houston, TX 77030, USA. Tel: +832-792-5305. E-mail: ziyadmss@gmail.com
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Abstract

Background:

Anomalous aortic origin of the left coronary artery with intraseptal course is a rare coronary anomaly associated with an increased risk of myocardial ischaemia. The role and techniques for surgical intervention are evolving, with numerous novel surgical techniques for this challenging anatomy reported in the last 5 years. We report our single-centre experience with surgical repair of intraseptal anomalous left coronary artery in the paediatric population, including clinical presentation, evaluation, and short- to mid-term outcomes.

Methods:

All patients with coronary anomalies presenting to our institution undergo standardised clinical evaluation. Five patients aged 4 to 17 years underwent surgical intervention for intraseptal anomalous aortic origin of the left coronary artery between 2012 and 2022. Surgical techniques included coronary artery bypass grafting (n = 1), direct reimplantation with limited supra-arterial myotomy via right ventriculotomy (n = 1), and transconal supra-arterial myotomy with right ventricular outflow tract patch reconstruction (n = 3).

Results:

All patients had evidence of haemodynamically significant coronary compression, and three had evidence of inducible myocardial ischaemia pre-operatively. There were no deaths or major complications. Median follow-up was 6.1 months (range 3.1–33.4 months). Patients who underwent supra-arterial myotomy (with or without reimplantation) had improved coronary flow and perfusion based on stress imaging and catheterisation data.

Conclusions:

Surgical approaches to intraseptal anomalous left coronary artery with evidence of myocardial ischaemia continue to evolve, with new techniques demonstrating promising improvement in coronary perfusion. Further studies are warranted to determine long-term outcomes and refine indications for repair.

Keywords

Anomalous aortic origin of coronary arteryanomalous left coronary arterycoronary anomaliescoronary unroofingintraseptal coronary
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 11 , November 2023 , pp. 2342 - 2349
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Brothers, JA, Frommelt, MA, Jaquiss, RDB, Myerburg, RJ, Fraser, CD Jr, Tweddell, JS. Expert consensus guidelines: anomalous aortic origin of a coronary artery. J Thorac Cardiovasc Surg. 2017 Jun;153:1440–1457. doi: 10.1016/j.jtcvs.2016.06.066. Epub 2017 Feb 4. PMID: 28274557.CrossRefGoogle ScholarPubMed
Molossi, S, Agrawal, H, Mery, CM, et al. Outcomes in anomalous aortic origin of a coronary artery following a prospective standardized approach. Circ Cardiovasc Interv. 2020 Feb;13:e008445. doi: 10.1161/CIRCINTERVENTIONS.119.008445. Epub 2020 Feb 13. PMID: 32069111.CrossRefGoogle ScholarPubMed
Doan, TT, Zea-Vera, R, Agrawal, H et al. Myocardial ischemia in children with anomalous aortic origin of a coronary artery with intraseptal course. Circ Cardiovasc Interv. 2020 Mar;13:e008375. doi: 10.1161/CIRCINTERVENTIONS.119.008375. Epub 2020 Feb 27. PMID: 32102565.CrossRefGoogle ScholarPubMed
Kothari, SS, Talwar, KK, Venugopal, P. Septal course of the left main coro- nary artery from right aortic sinus and ventricular tachycardia. Int J Cardiol. 1998;66:207–209. doi: 10.1016/s0167-5273(98)00218-6.CrossRefGoogle Scholar
Duke, C, Rosenthal, E, Simpson, JM. Myocardial infarction in infancy caused by compression of an anomalous left coronary artery arising from the right coronary artery. Cardiol Young. 2004;14:654–657. doi: 10.1017/S1047951104006092.CrossRefGoogle ScholarPubMed
Johnson, JN, Bonnichsen, CR, Julsrud, PR, Burkhart, HM, Hagler, DJ. Single coronary artery giving rise to an intraseptal left coronary artery in a patient presenting with neurocardiogenic syncope. Cardiol Young. 2011;21:572–576. doi: 10.1017/S1047951111000606.CrossRefGoogle Scholar
Glushko, T, Seifert, R, Brown, F, Vigilance, D, Iriarte, B, Teytelboym, OM. Trans- septal course of anomalous left main coronary artery originating from sin- gle right coronary orifice presenting as unstable angina. Radiol Case Rep. 2018;13:549–554. doi: 10.1016/j.radcr.2018.02.009.CrossRefGoogle Scholar
Doan, TT, Molossi, S, Qureshi, AM, McKenzie, ED. Intraseptal anomalous coronary artery with myocardial infarction: novel surgical approach. Ann Thorac Surg. 2020 Oct;110:e271–e274. doi: 10.1016/j.athoracsur.2020.02.076. Epub 2020 Apr 9. PMID: 32278751.CrossRefGoogle ScholarPubMed
Najm, HK, Ahmad, M. Transconal unroofing of anomalous left main coronary artery from right sinus with trans-septal course. Ann Thorac Surg. 2019 Dec;108:e383–e386. doi: 10.1016/j.athoracsur.2019.04.021. Epub 2019 May 15. PMID: 31102634.CrossRefGoogle ScholarPubMed
Najm, HK, Ahmad, M, Hammoud, MS, Costello, JP, Karamlou, T. Surgical pearls of the transconal unroofing procedure-modifications and midterm outcomes. Ann Thorac Surg. 2022 Apr;28:S0003–4975(22)00641–5. doi: 10.1016/j.athoracsur.2022.04.027. Epub ahead of print. PMID: 35490772.Google Scholar
Gaillard, M, Pontailler, M, Danial, P, et al. Anomalous aortic origin of coronary arteries: an alternative to the unroofing strategy. Eur J Cardiothorac Surg. 2020 Nov 1;58:975–982. doi: 10.1093/ejcts/ezaa129. PMID: 32572445.CrossRefGoogle Scholar
Agati, S, Secinaro, A, Caldaroni, F, et al. Perfusion study helps in the management of the intraseptal course of an anomalous coronary artery. World J Pediatr Congenit Heart Surg. 2019 May;10:360–363. doi: 10.1177/2150135119829004. PMID: 31084306.CrossRefGoogle ScholarPubMed
Williams, SB, Pham, TDN, Doan, TT, et al. Pattern, behavior, and clinical implications of electrocardiographic changes in patients undergoing repair of anomalous aortic origin of coronary arteries. J Thorac Cardiovasc Surg. 2022 Sep;164:742–749. doi: 10.1016/j.jtcvs.2022.01.047. Epub 2022 Feb 16. PMID: 35279290.CrossRefGoogle ScholarPubMed