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Unroofing Surgery for Anomalous Aortic Origin of the Right Coronary Artery: a single centre experience
Session:
SESSÃO DE POSTERS 54 - INTERVENÇÃO MITRAL PERCUTÂNEA E CIRURGIA CARDÍACA
Speaker:
Inês Alves
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.7 Non-Atherosclerotic Coronary Abnormalities
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Alves; Sara Ranchordás; João Aquino; Maria Resende; Paulo Oliveira; Márcio Madeira; Pedro Magro; José Neves; Marta Marques; Miguel Sousa-Uva; Miguel Abecasis
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction: </strong>Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus is a rare congenital coronary anomaly, which may involve the left or right coronary artery (RCA). The incidence of anomalous aortic origin of the RCA (ARCA) is around 0.05% to 0.1%. Clinical presentation can vary from asymptomatic to sudden cardiac death. The aim of this study is to assess the safety and efficacy of ARCA surgery in one tertiary hospital.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Materials and methods: </strong>A retrospective observational study including all patients who underwent surgery for ARCA from january 2016 to december 2024 was performed. All cases were ARCA from the left coronary sinus. A total of 26 patients were submitted to surgery. Concomitant procedures were performed in 8 cases.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Surgery was performed by median sternotomy with conventional cardiopulmonary bypass, aortic cross clamping and cardioplegic arrest. Through a transverse aortotomy the anomalous intramural portion of the RCA was accessed. A probe was placed inside the intramural course of the RCA and the intra-aortic roof of the artery was sharply opened throughout the intramural pathway from the origin to take-off in right coronary sinus. Edges were tacked down with fine sutures. When the intramural course was behind the right-to-left commissure, the procedure also included detaching and resuspension of the commissure.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results: </strong>The mean population age was 40 (8 to 76) years, and 69% were males. Most patients were symptomatic (19 cases), with acute and chronic coronary syndrome, fatigue/dyspnoea and syncope. Two patients presented with cardiac arrest. Two patients were diagnosed intra-operatively. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Mean CPB time was 69 (±47) minutes and mean aortic cross-clamping time was 49 (±31) minutes. One patient had a postoperative myocardial infarction with a subocclusion of the proximal RCA in the first day post-op.<strong> </strong>The patient underwent percutaneous coronary intervention with stenting of the RCA and was discharged in day 8 post-op, with no further complications.<strong> </strong>There were no other postoperative complications or in-hospital mortality. Mean ICU stay was below 2 days, and all were discharged home within 9 days after surgery (3 to 9 days). After a mean follow-up time of 2 years (6 days to 8 years), all patients were alive. One patient had a pacemaker implanted 2 months after surgery due to second degree AV block (Mobitz II), which was not present immediately after surgery. There were no other events during follow up.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusions: </strong>ARCA is a rare but potentially fatal condition. Patients with malignant course or evidence of ischemia should undergo surgical treatment. Unroofing is a simple, safe and effective procedure for ARCA.</span></span></p>
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