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Transection And Re-implantation Of An Anomalous Aortic Origin Of The Right Coronary Artery: How I Do It
Ziyad Binsalamah, carlos Bonilla-Ramirez, Shagun Sachdeva, Prakash Masand, Dana Reaves-O'Neal, Christopher Caldarone, Silvana Molossi, Jeffrey Heinle.
Baylor College of Medicine, Houston, TX, USA.

Objective(s):
We present a case and surgical video of coronary transection and reimplantation for the surgical treatment of anomalous aortic origin of the coronary artery (AAOCA).
Methods:
A 14-year old male was referred after an incidental echocardiographic finding of a right coronary artery (RCA) arising from the left coronary sinus. The patient was evaluated by computed tomography angiography (CTA) and stress cardiac magnetic resonance (sCMR) to assess myocardial perfusion.
Results:
Preoperative CTA showed an RCA arising from the left coronary sinus with a 6 mm intramural course and a slit-like orifice. Preoperative sCMR showed an inducible subendocardial perfusion defect in the septum. Based on the findings of ischemia, the patient was offered surgical repair. During surgery, it was determined that coronary unroofing was not feasible as the coronary passes behind the inter-coronary pillar which supports the aortic valve. The decision was made to reimplant the RCA into the right coronary sinus without attempting unroofing. The anomalous RCA was transected as it exited the aortic root and the coronary stump was closed. The transected coronary was sutured into an appropriate site within the right coronary sinus. After 3 months, the patient remained asymptomatic and postoperative CTA showed an RCA arising from a round, patent ostium within the right coronary sinus. Postoperative sCMR revealed normal perfusion with no inducible defects.
Conclusions:
Coronary artery transection and reimplantation is a useful surgical alternative in AAOCA with an intramural course through the intercoronary pillar where unroofing does not relocate the ostium into the appropriate sinus


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