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Anomalous aortic origin of the right coronary artery: single centre experience
Session:
Posters (Sessão 3 - Écran 1) - Cardiopatias Congénitas no Adulto
Speaker:
Sara Ranchordás
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.4 Congenital Heart Disease – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Sara Ranchordás; Paulo Veiga Oliveira; Márcio Madeira; Marta Marques; José Pedro Neves; Miguel Abecasis
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Introduction:</span></span></strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">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). Prevalence ranges from 0.1 to 1% in different series. Clinical presentation can vary from asymptomatic to sudden cardiac death. The main objective of this study was to evaluate our centre´s experience of surgery in patients with anomalous aortic origin of the RCA (AAORCA).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Materials and methods:</span></span></strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All patients who underwent surgery for AAORCA from january 2016 to may 2021 were included. All cases were AAORCA from the left coronary sinus. A total of 7 patients (5 male, 2 female) were submitted to surgery by the same surgeon. No concomitant procedures were performed.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Surgical technique consisted of median sternotomy, establishment of conventional cardiopulmonary bypass and aortic cross clamping with cardioplegic arrest. Transverse aortotomy was made to gain access to the anomalous intramural portion of the right coronary artery. 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 in left coronary sinus to take-off in right coronary sinus. Edges were tacked down with fine sutures. There was one case with intramural course behind the right-to-left commissure. The commissure was therefore detached and resuspended.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Results:</span></span></strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean age was 42 years old. All patients were symptomatic: 2 presented with cardiac arrest, 4 with effort angina, and 1 with easy fatigue/effort related dyspnoea. All had an AAORCA with intramural course, a slit like ostium in 2 patients, both of which presented with cardiac arrest during exercise. Mean CPB time was 41.9 (±7.5; 35-54) minutes and mean aortic cross-clamping time was 28.4 (±5.9; 22-38) minutes. There were no postoperative complications nor in-hospital mortality, ICU stay was < 48h, and all were discharged home within 7 days after surgery (3-7 days). After a mean follow time of 2.5 years, all patients were alive. One patient had a pacemaker implanted 2 months after surgery due to 2nd grade 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="background-color:white"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Conclusions: </span></span></strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ARCA is a rare but potentially fatal condition. Slit like ostium is a particularly high risk characteristic. Unroofing is a simple, safe and effective procedure for ARCA.</span></span></p>
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