Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery

Robert L. Romp, J. René Herlong, Carolyn K. Landolfo, Stephen P. Sanders, Coleen E. Miller, Ross M. Ungerleider, James Jaggers, Carl Backer, Scott Bradley, Constantine Mavroudis, John Brown

Research output: Contribution to journalArticle

139 Citations (Scopus)

Abstract

Background. Anomalous aortic origin of a coronary artery (AAOCA) from an incorrect sinus of Valsalva is a relatively rare congenital defect and is associated with sudden death. Several surgical techniques have been described to address this defect, but functional outcome has never been addressed. In this report we evaluate a consecutive series of patients treated with unroofing techniques using transthoracic echocardiography, graded exercise testing, and stress echocardiography to assess functional repair. Methods. Nine consecutive patients (range 7 to 65 years) underwent surgical repair of AAOCA from 1995 to 2001. In all patients the intramural segment was at or below the level of the commissure. All patients underwent a modified unroofing procedure to move the coronary artery orifice to the appropriate sinus. In 2 patients, a new orifice was created without significant unroofing and disruption of the commissure. Patients were evaluated prospectively with exercise electrocardiography testing and by resting and stress echocardiography. Results. Of the 9 patients, 8 presented with symptoms suggestive of ischemia (chest pain, dyspnea on exertion, or syncope). Six patients had anomalous left main coronary artery arising from the right sinus of Valsalva, and 3 patients had anomalous right coronary artery from the left sinus of Valsalva. Transthoracic echocardiography and graded exercise testing was performed in all 9 patients (mean 29 months, range 4 to 85 months) after repair. Of the 9 patients, 8 also underwent stress echocardiography. In 8 of 9 patients the newly created coronary artery ostium was visualized by either two-dimensional echocardiography or color flow Doppler. All patients were symptom free at the time of follow-up. Exercise stress echocardiography was negative in all patients. Of the 8 patients, 7 had normal left ventricular shortening. No patients had regional wall motion abnormalities suggestive of ischemia. All patients were intervention free except 1 patient who developed severe aortic insufficiency and underwent a subsequent Ross procedure 44 months after his initial procedure. Conclusions. Anomalous origin of a coronary artery from an incorrect sinus of Valsalva is known to be associated with increased risk of sudden death. Surgical correction can be carried out with minimal risk and good anatomic and functional results. Manipulation of the commissure can be avoided by creation of a neo-ostia without extensive unroofing of the intramural segment or manipulation of the intercoronary commissure. This may avoid aortic valve malfunction.

Original languageEnglish (US)
Pages (from-to)589-596
Number of pages8
JournalAnnals of Thoracic Surgery
Volume76
Issue number2
DOIs
StatePublished - Aug 1 2003
Externally publishedYes

Fingerprint

Coronary Vessels
Stress Echocardiography
Sinus of Valsalva
Exercise
Echocardiography
Sudden Death
Ischemia
Syncope
Chest Pain
Aortic Valve
Dyspnea
Electrocardiography
Color

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery. / Romp, Robert L.; Herlong, J. René; Landolfo, Carolyn K.; Sanders, Stephen P.; Miller, Coleen E.; Ungerleider, Ross M.; Jaggers, James; Backer, Carl; Bradley, Scott; Mavroudis, Constantine; Brown, John.

In: Annals of Thoracic Surgery, Vol. 76, No. 2, 01.08.2003, p. 589-596.

Research output: Contribution to journalArticle

Romp, RL, Herlong, JR, Landolfo, CK, Sanders, SP, Miller, CE, Ungerleider, RM, Jaggers, J, Backer, C, Bradley, S, Mavroudis, C & Brown, J 2003, 'Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery', Annals of Thoracic Surgery, vol. 76, no. 2, pp. 589-596. https://doi.org/10.1016/S0003-4975(03)00436-3
Romp, Robert L. ; Herlong, J. René ; Landolfo, Carolyn K. ; Sanders, Stephen P. ; Miller, Coleen E. ; Ungerleider, Ross M. ; Jaggers, James ; Backer, Carl ; Bradley, Scott ; Mavroudis, Constantine ; Brown, John. / Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery. In: Annals of Thoracic Surgery. 2003 ; Vol. 76, No. 2. pp. 589-596.
@article{966e7bd35f7c4f27b8e5cf2acd960592,
title = "Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery",
abstract = "Background. Anomalous aortic origin of a coronary artery (AAOCA) from an incorrect sinus of Valsalva is a relatively rare congenital defect and is associated with sudden death. Several surgical techniques have been described to address this defect, but functional outcome has never been addressed. In this report we evaluate a consecutive series of patients treated with unroofing techniques using transthoracic echocardiography, graded exercise testing, and stress echocardiography to assess functional repair. Methods. Nine consecutive patients (range 7 to 65 years) underwent surgical repair of AAOCA from 1995 to 2001. In all patients the intramural segment was at or below the level of the commissure. All patients underwent a modified unroofing procedure to move the coronary artery orifice to the appropriate sinus. In 2 patients, a new orifice was created without significant unroofing and disruption of the commissure. Patients were evaluated prospectively with exercise electrocardiography testing and by resting and stress echocardiography. Results. Of the 9 patients, 8 presented with symptoms suggestive of ischemia (chest pain, dyspnea on exertion, or syncope). Six patients had anomalous left main coronary artery arising from the right sinus of Valsalva, and 3 patients had anomalous right coronary artery from the left sinus of Valsalva. Transthoracic echocardiography and graded exercise testing was performed in all 9 patients (mean 29 months, range 4 to 85 months) after repair. Of the 9 patients, 8 also underwent stress echocardiography. In 8 of 9 patients the newly created coronary artery ostium was visualized by either two-dimensional echocardiography or color flow Doppler. All patients were symptom free at the time of follow-up. Exercise stress echocardiography was negative in all patients. Of the 8 patients, 7 had normal left ventricular shortening. No patients had regional wall motion abnormalities suggestive of ischemia. All patients were intervention free except 1 patient who developed severe aortic insufficiency and underwent a subsequent Ross procedure 44 months after his initial procedure. Conclusions. Anomalous origin of a coronary artery from an incorrect sinus of Valsalva is known to be associated with increased risk of sudden death. Surgical correction can be carried out with minimal risk and good anatomic and functional results. Manipulation of the commissure can be avoided by creation of a neo-ostia without extensive unroofing of the intramural segment or manipulation of the intercoronary commissure. This may avoid aortic valve malfunction.",
author = "Romp, {Robert L.} and Herlong, {J. Ren{\'e}} and Landolfo, {Carolyn K.} and Sanders, {Stephen P.} and Miller, {Coleen E.} and Ungerleider, {Ross M.} and James Jaggers and Carl Backer and Scott Bradley and Constantine Mavroudis and John Brown",
year = "2003",
month = "8",
day = "1",
doi = "10.1016/S0003-4975(03)00436-3",
language = "English (US)",
volume = "76",
pages = "589--596",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery

AU - Romp, Robert L.

AU - Herlong, J. René

AU - Landolfo, Carolyn K.

AU - Sanders, Stephen P.

AU - Miller, Coleen E.

AU - Ungerleider, Ross M.

AU - Jaggers, James

AU - Backer, Carl

AU - Bradley, Scott

AU - Mavroudis, Constantine

AU - Brown, John

PY - 2003/8/1

Y1 - 2003/8/1

N2 - Background. Anomalous aortic origin of a coronary artery (AAOCA) from an incorrect sinus of Valsalva is a relatively rare congenital defect and is associated with sudden death. Several surgical techniques have been described to address this defect, but functional outcome has never been addressed. In this report we evaluate a consecutive series of patients treated with unroofing techniques using transthoracic echocardiography, graded exercise testing, and stress echocardiography to assess functional repair. Methods. Nine consecutive patients (range 7 to 65 years) underwent surgical repair of AAOCA from 1995 to 2001. In all patients the intramural segment was at or below the level of the commissure. All patients underwent a modified unroofing procedure to move the coronary artery orifice to the appropriate sinus. In 2 patients, a new orifice was created without significant unroofing and disruption of the commissure. Patients were evaluated prospectively with exercise electrocardiography testing and by resting and stress echocardiography. Results. Of the 9 patients, 8 presented with symptoms suggestive of ischemia (chest pain, dyspnea on exertion, or syncope). Six patients had anomalous left main coronary artery arising from the right sinus of Valsalva, and 3 patients had anomalous right coronary artery from the left sinus of Valsalva. Transthoracic echocardiography and graded exercise testing was performed in all 9 patients (mean 29 months, range 4 to 85 months) after repair. Of the 9 patients, 8 also underwent stress echocardiography. In 8 of 9 patients the newly created coronary artery ostium was visualized by either two-dimensional echocardiography or color flow Doppler. All patients were symptom free at the time of follow-up. Exercise stress echocardiography was negative in all patients. Of the 8 patients, 7 had normal left ventricular shortening. No patients had regional wall motion abnormalities suggestive of ischemia. All patients were intervention free except 1 patient who developed severe aortic insufficiency and underwent a subsequent Ross procedure 44 months after his initial procedure. Conclusions. Anomalous origin of a coronary artery from an incorrect sinus of Valsalva is known to be associated with increased risk of sudden death. Surgical correction can be carried out with minimal risk and good anatomic and functional results. Manipulation of the commissure can be avoided by creation of a neo-ostia without extensive unroofing of the intramural segment or manipulation of the intercoronary commissure. This may avoid aortic valve malfunction.

AB - Background. Anomalous aortic origin of a coronary artery (AAOCA) from an incorrect sinus of Valsalva is a relatively rare congenital defect and is associated with sudden death. Several surgical techniques have been described to address this defect, but functional outcome has never been addressed. In this report we evaluate a consecutive series of patients treated with unroofing techniques using transthoracic echocardiography, graded exercise testing, and stress echocardiography to assess functional repair. Methods. Nine consecutive patients (range 7 to 65 years) underwent surgical repair of AAOCA from 1995 to 2001. In all patients the intramural segment was at or below the level of the commissure. All patients underwent a modified unroofing procedure to move the coronary artery orifice to the appropriate sinus. In 2 patients, a new orifice was created without significant unroofing and disruption of the commissure. Patients were evaluated prospectively with exercise electrocardiography testing and by resting and stress echocardiography. Results. Of the 9 patients, 8 presented with symptoms suggestive of ischemia (chest pain, dyspnea on exertion, or syncope). Six patients had anomalous left main coronary artery arising from the right sinus of Valsalva, and 3 patients had anomalous right coronary artery from the left sinus of Valsalva. Transthoracic echocardiography and graded exercise testing was performed in all 9 patients (mean 29 months, range 4 to 85 months) after repair. Of the 9 patients, 8 also underwent stress echocardiography. In 8 of 9 patients the newly created coronary artery ostium was visualized by either two-dimensional echocardiography or color flow Doppler. All patients were symptom free at the time of follow-up. Exercise stress echocardiography was negative in all patients. Of the 8 patients, 7 had normal left ventricular shortening. No patients had regional wall motion abnormalities suggestive of ischemia. All patients were intervention free except 1 patient who developed severe aortic insufficiency and underwent a subsequent Ross procedure 44 months after his initial procedure. Conclusions. Anomalous origin of a coronary artery from an incorrect sinus of Valsalva is known to be associated with increased risk of sudden death. Surgical correction can be carried out with minimal risk and good anatomic and functional results. Manipulation of the commissure can be avoided by creation of a neo-ostia without extensive unroofing of the intramural segment or manipulation of the intercoronary commissure. This may avoid aortic valve malfunction.

UR - http://www.scopus.com/inward/record.url?scp=0042158256&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0042158256&partnerID=8YFLogxK

U2 - 10.1016/S0003-4975(03)00436-3

DO - 10.1016/S0003-4975(03)00436-3

M3 - Article

C2 - 12902110

AN - SCOPUS:0042158256

VL - 76

SP - 589

EP - 596

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 2

ER -