Poynter Jeffrey A, Bondarenko Igor, Austin Erle H, DeCampli William M, Jacobs Jeffrey P, Ziemer Gerhard, Kirshbom Paul M, Tchervenkov Christo I, Karamlou Tara, Blackstone Eugene H, Walters Henry L, Gaynor J William, Mery Carlos M, Pearl Jeffrey M, Brothers Julie A, Caldarone Christopher A, Williams William G, Jacobs Marshall L, Mavroudis Constantine
Congenital Heart Surgeons Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, MI, USA.
World J Pediatr Congenit Heart Surg. 2014 Oct;5(4):507-14. doi: 10.1177/2150135114540182.
Anomalous aortic origin of a coronary artery (AAOCA) encompasses a wide morphologic spectrum, which has impeded consensus regarding indications for the diverse repair strategies. We constructed a profile of current surgical techniques and explore their application to morphologic variants.
Patients<30 years old (n=113) with isolated AAOCA who underwent operations at 29 Congenital Heart Surgeons Society (CHSS) institutions from 1998 to 2012 were identified from the CHSS AAOCA Registry. Operative findings were related to surgical techniques at index repairs by cross-tabulation.
Anomalous origin of the left main or left anterior descending coronary artery was present in 33 (29%) patients and of the right coronary artery in 78 (69%) patients; 2 arteries originated directly above the commissure between the left and right sinuses. There were 101 (89%) interarterial and intramural (IA/IM) arteries, 10 (9%) were interarterial but not intramural (IA/NIM) and 2 (2%) were neither interarterial nor intramural. Intramural arteries were unroofed in 100 (88%) operations, usually with intimal tacking after incision (n=47) or excision (n=25) of the common wall. Coronary reimplantation (n=11), pulmonary artery relocation (n=7; 5 for IA/NIM), simple ostioplasty (without unroofing; n=3), coronary artery bypass grafting (n=2), and ostial window (n=1) were less common. In 37 (33%) operations, a valvar commissure was taken down; 33 were resuspended.
Current surgical repair of AAOCA is individualized to morphology, particularly the presence of intramural and/or interarterial segments. This report is foundational for future planned CHSS studies that will examine interventional and noninterventional outcomes and ultimately guide management of AAOCA.
冠状动脉异常起源（AAOCA）涵盖广泛的形态学谱，这阻碍了就各种修复策略的适应证达成共识。我们构建了当前手术技术的概况，并探讨它们在形态学变异中的应用。
从先天性心脏病外科医生协会（CHSS）AAOCA登记处识别出1998年至2012年在29家CHSS机构接受手术的30岁以下孤立性AAOCA患者（n = 113）。通过交叉列表将手术结果与初次修复时的手术技术相关联。
33例（29%）患者存在左主干或左前降支冠状动脉异常起源，78例（69%）患者存在右冠状动脉异常起源；2支动脉直接起源于左右窦之间的瓣叶联合上方。有101支（89%）动脉位于动脉间和壁内（IA/IM），10支（9%）为动脉间但非壁内（IA/NIM），2支（2%）既非动脉间也非壁内。100例（88%）手术中对壁内动脉进行了去顶术，通常在切开（n = 47）或切除（n = 25）共同壁后进行内膜固定。冠状动脉再植术（n = 11）、肺动脉移位术（n = 7；5例用于IA/NIM）、单纯开口成形术（未去顶；n = 3）、冠状动脉旁路移植术（n = 2）和开口窗口术（n = 1）较少见。在37例（33%）手术中，切除了瓣膜联合；33例进行了重新悬吊。
目前AAOCA的手术修复是根据形态学个体化的，特别是壁内和/或动脉间节段的存在情况。本报告为CHSS未来计划的研究奠定了基础，这些研究将检查介入和非介入结果，并最终指导AAOCA的管理。
