Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery

Sunjay Kaushal, Carl L. Backer, Andrada R. Popescu, Brandon L. Walker, Hyde M. Russell, Peter R. Koenig, Cynthia K. Rigsby, Constantine Mavroudis

Research output: Contribution to journalArticle

Abstract

Background: Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva is a rare congenital anomaly with the potential for myocardial ischemia and sudden death. This review evaluated our series of AAOCA patients, who underwent coronary artery unroofing, to test our hypothesis that the intramural length of the anomalous coronary artery correlates with symptoms. Methods: A retrospective analysis of symptoms, preoperative imaging (computed tomography and magnetic resonance imaging), intraoperative assessment, perioperative course, and follow-up were reviewed. Results: From 2005 to 2010, 27 patients (70% male) underwent surgical AAOCA repair. Mean age was 14.3 ± 12 (range, 6 to 52) years. In 25 patients with right AAOCA, 14 had chest pain and 4 had syncope. Both patients with left AAOCA had chest pain. AAOCA unroofing was done in 25 and side-to-side anastomosis in 2. The intramural coronary artery length measured intraoperatively correlated with preoperative symptoms (symptoms = 10 ± 3.58 mm, no symptoms = 5.2 ± 1.5 mm, p <.002), as did preoperative imaging measurements (symptoms = 7.8 ± 2.8 mm, no symptoms = 5.3 ± 0.8 mm, p <.001). Preoperative imaging strongly predicted the intraoperative measurement (r = 0.81, p = 0.00001). There were no deaths, significant morbidity, or recurrence of symptoms. Conclusions: Coronary unroofing for AAOCA is a safe method of enlarging the coronary orifice and eliminating the intramural course. Symptomatic patients had a longer intramural course than asymptomatic patients, as assessed by preoperative imaging and intraoperative measurements. These results may have important clinical implications in determining indications for operation.

Original languageEnglish (US)
Pages (from-to)986-992
Number of pages7
JournalAnnals of Thoracic Surgery
Volume92
Issue number3
DOIs
StatePublished - Sep 1 2011
Externally publishedYes

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Coronary Vessels
Chest Pain
Sinus of Valsalva
Syncope
Patient Rights
Sudden Death
Myocardial Ischemia
Tomography
Magnetic Resonance Imaging
Morbidity
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery. / Kaushal, Sunjay; Backer, Carl L.; Popescu, Andrada R.; Walker, Brandon L.; Russell, Hyde M.; Koenig, Peter R.; Rigsby, Cynthia K.; Mavroudis, Constantine.

In: Annals of Thoracic Surgery, Vol. 92, No. 3, 01.09.2011, p. 986-992.

Research output: Contribution to journalArticle

Kaushal, Sunjay ; Backer, Carl L. ; Popescu, Andrada R. ; Walker, Brandon L. ; Russell, Hyde M. ; Koenig, Peter R. ; Rigsby, Cynthia K. ; Mavroudis, Constantine. / Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery. In: Annals of Thoracic Surgery. 2011 ; Vol. 92, No. 3. pp. 986-992.
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abstract = "Background: Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva is a rare congenital anomaly with the potential for myocardial ischemia and sudden death. This review evaluated our series of AAOCA patients, who underwent coronary artery unroofing, to test our hypothesis that the intramural length of the anomalous coronary artery correlates with symptoms. Methods: A retrospective analysis of symptoms, preoperative imaging (computed tomography and magnetic resonance imaging), intraoperative assessment, perioperative course, and follow-up were reviewed. Results: From 2005 to 2010, 27 patients (70{\%} male) underwent surgical AAOCA repair. Mean age was 14.3 ± 12 (range, 6 to 52) years. In 25 patients with right AAOCA, 14 had chest pain and 4 had syncope. Both patients with left AAOCA had chest pain. AAOCA unroofing was done in 25 and side-to-side anastomosis in 2. The intramural coronary artery length measured intraoperatively correlated with preoperative symptoms (symptoms = 10 ± 3.58 mm, no symptoms = 5.2 ± 1.5 mm, p <.002), as did preoperative imaging measurements (symptoms = 7.8 ± 2.8 mm, no symptoms = 5.3 ± 0.8 mm, p <.001). Preoperative imaging strongly predicted the intraoperative measurement (r = 0.81, p = 0.00001). There were no deaths, significant morbidity, or recurrence of symptoms. Conclusions: Coronary unroofing for AAOCA is a safe method of enlarging the coronary orifice and eliminating the intramural course. Symptomatic patients had a longer intramural course than asymptomatic patients, as assessed by preoperative imaging and intraoperative measurements. These results may have important clinical implications in determining indications for operation.",
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T1 - Intramural coronary length correlates with symptoms in patients with anomalous aortic origin of the coronary artery

AU - Kaushal, Sunjay

AU - Backer, Carl L.

AU - Popescu, Andrada R.

AU - Walker, Brandon L.

AU - Russell, Hyde M.

AU - Koenig, Peter R.

AU - Rigsby, Cynthia K.

AU - Mavroudis, Constantine

PY - 2011/9/1

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N2 - Background: Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva is a rare congenital anomaly with the potential for myocardial ischemia and sudden death. This review evaluated our series of AAOCA patients, who underwent coronary artery unroofing, to test our hypothesis that the intramural length of the anomalous coronary artery correlates with symptoms. Methods: A retrospective analysis of symptoms, preoperative imaging (computed tomography and magnetic resonance imaging), intraoperative assessment, perioperative course, and follow-up were reviewed. Results: From 2005 to 2010, 27 patients (70% male) underwent surgical AAOCA repair. Mean age was 14.3 ± 12 (range, 6 to 52) years. In 25 patients with right AAOCA, 14 had chest pain and 4 had syncope. Both patients with left AAOCA had chest pain. AAOCA unroofing was done in 25 and side-to-side anastomosis in 2. The intramural coronary artery length measured intraoperatively correlated with preoperative symptoms (symptoms = 10 ± 3.58 mm, no symptoms = 5.2 ± 1.5 mm, p <.002), as did preoperative imaging measurements (symptoms = 7.8 ± 2.8 mm, no symptoms = 5.3 ± 0.8 mm, p <.001). Preoperative imaging strongly predicted the intraoperative measurement (r = 0.81, p = 0.00001). There were no deaths, significant morbidity, or recurrence of symptoms. Conclusions: Coronary unroofing for AAOCA is a safe method of enlarging the coronary orifice and eliminating the intramural course. Symptomatic patients had a longer intramural course than asymptomatic patients, as assessed by preoperative imaging and intraoperative measurements. These results may have important clinical implications in determining indications for operation.

AB - Background: Anomalous aortic origin of a coronary artery (AAOCA) from the opposite sinus of Valsalva is a rare congenital anomaly with the potential for myocardial ischemia and sudden death. This review evaluated our series of AAOCA patients, who underwent coronary artery unroofing, to test our hypothesis that the intramural length of the anomalous coronary artery correlates with symptoms. Methods: A retrospective analysis of symptoms, preoperative imaging (computed tomography and magnetic resonance imaging), intraoperative assessment, perioperative course, and follow-up were reviewed. Results: From 2005 to 2010, 27 patients (70% male) underwent surgical AAOCA repair. Mean age was 14.3 ± 12 (range, 6 to 52) years. In 25 patients with right AAOCA, 14 had chest pain and 4 had syncope. Both patients with left AAOCA had chest pain. AAOCA unroofing was done in 25 and side-to-side anastomosis in 2. The intramural coronary artery length measured intraoperatively correlated with preoperative symptoms (symptoms = 10 ± 3.58 mm, no symptoms = 5.2 ± 1.5 mm, p <.002), as did preoperative imaging measurements (symptoms = 7.8 ± 2.8 mm, no symptoms = 5.3 ± 0.8 mm, p <.001). Preoperative imaging strongly predicted the intraoperative measurement (r = 0.81, p = 0.00001). There were no deaths, significant morbidity, or recurrence of symptoms. Conclusions: Coronary unroofing for AAOCA is a safe method of enlarging the coronary orifice and eliminating the intramural course. Symptomatic patients had a longer intramural course than asymptomatic patients, as assessed by preoperative imaging and intraoperative measurements. These results may have important clinical implications in determining indications for operation.

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