Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Emory University School of Medicine, Atlanta, GA, USA.
Heart Lung Circ. 2024 Apr;33(4):510-517. doi: 10.1016/j.hlc.2024.01.028. Epub 2024 Feb 24.
The management of adult patients with anomalous aortic origin of the right coronary artery (ARCA) from the left aortic sinus poses important challenges. The presence of symptoms or documented ischaemia, the anatomical characteristics of the ostium, and the course of the coronary determine decision-making.
A retrospective review was performed of all cases of surgical management of ARCA at a single centre. The primary endpoints were mortality and myocardial infarction at 30 days. Secondary endpoints included recurrence of symptoms, freedom from re-intervention, and mortality during long-term follow-up.
From October 2019 to August 2023, 15 adult patients underwent surgery for ARCA; 13 patients were included in this study (mean age 53.9±11.1 years; 10 female). A slit-like orifice, a long intramural segment, and an interarterial course were found in all patients. Twelve (12) patients (92.3%) were symptomatic: nine with angina, combined with dyspnoea on exertion in seven. One (1) patient had history of pre-syncope. One (1) patient presented with out-of-hospital cardiac arrest. All patients underwent formal unroofing of the orifice and intramural portion of the ARCA; five patients had a concomitant procedure. No 30-day mortality nor myocardial infarction was recorded. At a mean follow-up of 20.1±12.8 months, all patients were alive. One (1) patient (7.6%) developed recurrent dyspnoea; investigations showed no ischaemia. No repeated interventions were required.
Surgical unroofing of anomalous coronary artery in the adult is safe and effective; correction of both the slit-like orifice and intramural portion of the anomaly provides a durable result in patients with ARCA.
成人异常起源于左主动脉窦的右冠状动脉（ARCA）的管理带来了重要挑战。症状的存在或有记录的缺血、窦口的解剖特征和冠状动脉的行程决定了决策。
对单一中心所有 ARCA 手术治疗病例进行回顾性分析。主要终点是 30 天内的死亡率和心肌梗死。次要终点包括症状复发、无再干预和长期随访期间的死亡率。
从 2019 年 10 月至 2023 年 8 月，15 名成人患者接受了 ARCA 手术；13 名患者纳入本研究（平均年龄 53.9±11.1 岁；10 名女性）。所有患者均发现窦口呈裂隙状、管腔段较长且走行于动脉之间。12 名（12）患者（92.3%）有症状：9 名胸痛，7 名伴有劳力性呼吸困难。1 名（1）患者有晕厥前病史。1 名（1）患者出现院外心脏骤停。所有患者均接受了正式的窦口和 ARCA 管腔段的开窗术；5 名患者同时进行了其他手术。无 30 天死亡率或心肌梗死。平均随访 20.1±12.8 个月，所有患者均存活。1 名（1）患者（7.6%）出现复发性呼吸困难；检查未发现缺血。无需再次介入治疗。
成人异常冠状动脉开窗术是安全有效的；纠正裂隙状窦口和管腔段异常可使 ARCA 患者获得持久的效果。
