3 Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece.
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada.
Coron Artery Dis. 2023 Aug 1;34(5):364-371. doi: 10.1097/MCA.0000000000001247. Epub 2023 May 1.
Coronary artery anomalies are a diverse group of congenital disorders presenting with highly variable clinical manifestations. The anomalous origin of left circumflex artery from the right coronary sinus following a retro-aortic trajectory is a well-recognized anatomic variation. Despite its benign course, it can prove lethal in association with valvular surgery. When single aortic valve replacement or combined with mitral valve replacement is performed, the aberrant coronary vessel may be compressed by or between the prosthetic rings triggering postoperative lateral myocardial ischemia. If left untreated, the patient is at risk of sudden death or myocardial infarction with its detrimental complications. Skeletonization and mobilization of the aberrant coronary artery is the most widely accepted intervention, but valve downsizing or concomitant surgical or transcatheter revascularization have also been described. However, large series are lacking from the literature. Therefore, no guidelines exist. This study is a thorough review of the literature concerning the aforementioned anomaly in association with valvular surgery.
冠状动脉异常是一组表现高度可变的先天性疾病。左回旋支动脉从主动脉后方向右冠状动脉窦异常起源是一种公认的解剖变异。尽管它的病程良性，但在与瓣膜手术相关时可能是致命的。当进行单瓣置换或联合二尖瓣置换时，异常的冠状动脉可能会被假体环压迫或夹在中间，引发术后外侧心肌缺血。如果不治疗，患者有发生猝死或心肌梗死及其不良并发症的风险。异常冠状动脉的骨骼化和游离是最广泛接受的干预措施，但也有报道称瓣膜缩小或同时进行手术或经导管血运重建。然而，文献中缺乏大型系列报道。因此，目前没有相关指南。本研究对与瓣膜手术相关的上述异常的文献进行了全面回顾。
