Anomalous coronary artery from the wrong sinus of Valsalva: a physiologic repair strategy.
BACKGROUND
A coronary artery arising from the wrong aortic sinus, with or without a proximal course between the aorta and the pulmonary artery, may predispose to myocardial ischemia, myocardial infarction, or sudden death.


METHODS
We repaired this lesion in 5 symptomatic patients, all of whom had experienced exercise-related chest pain, dyspnea, or syncopal episodes. All patients underwent patch angioplasty of the proximal anomalous coronary artery with glutaraldehyde-treated autologous pericardium. When the coronary artery coursed between the aorta and the main pulmonary artery, the main pulmonary artery was translocated toward the left pulmonary artery to create additional space and prevent compression.


RESULTS
All patients recovered well and to date have demonstrated no evidence of recurrent myocardial ischemia.


CONCLUSIONS
The combination of coronary artery angioplasty and translocation of the pulmonary artery seems to effectively address all the mechanisms that can generate ischemia.
Alphonso
Nelson
N
Pediatric Heart Center, UCSF Children's Hospital, University of California San Francisco, San Francisco, California 94143, USA.
Anagnostopoulos
Petros V
PV
Nölke
Lars
L
Moon-Grady
Anita
A
Azakie
Anthony
A
Raff
Gary W
GW
Karl
Tom R
TR
D000293:Adolescent; D000714:Anastomosis, Surgical; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging* / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012494:Sampling Studies; D012850:Sinus of Valsalva / Q000002:abnormalities*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*