Congenital anomalies of the coronary arteries

Question 0

What diagnostic imaging is necessary

Answer 0

Resting ECG as a baseline

Echocardiography to assess for normal intracardiac anatomy and to evaluate heart function. Color doppler can be locate position of coronary arteries.

CT/MRI maybe useful.

Myocardial ischemia at rest and stress needs to be assessed. Exercise stress test (nuclear perfusion scan, stress echocardiography)

Question 1

What is pathophysiology of anomalous coronary artery course between aorta and PA?

Answer 1

Can result in myocardial ischemia and sudden death, notably in children and young adults

Greatest danger is the LMCA coming from the right sinus. Risk of death greatest with exercise

0.1% to 0.3% of the general population.

Question 2

What are indications for surgery

Answer 2

Surgery is indicated in any patient with interarterial course who has signs or symptoms of myocardial ischemia or ventricular arrhythmias.

Also, most believe surgery IS indicated in patients with an anomalous left coronary artery because of high risk of sudden death.

Question 3

What are surgical techniques for anomalies of coronary arteries

Answer 3

Unroofing procedure: procedure of choice.Open the slit-like ostium longitudinally start at the anomalous coronary os continuing into the correct sinus. A segment of the common wall between the aorta and the coronary is excised and the intimal surfaces are approximated.

creation of neo-ostium: probe passed through the intramural segment of the ACA into the correct sinu. The coronary artery is opened where it exits the aortic wall and then neo-ostium is created there.

Coronary artery translocation with reimplntation: coronary artery is excised with a button

Coronary bypass with either vein or artery can be performed.