title: Surgery for anomalous origin of the left main coronary artery from the right sinus of Valsalva, in association with left main stenosis.
abstract: Most medical literature regarding the anomalous origin of a coronary artery from the opposite sinus of Valsalva pertains to sudden death in the young. The surgical treatment of anomalous origin of the left main coronary artery from the right sinus of Valsalva is not particularly well codified, and when an anomalous left main coronary artery is associated with an extramural stenosis, treatment becomes more technically challenging. Herein, we describe a unique approach toward treating this combination of conditions. A 15-year-old adolescent boy was diagnosed with anomalous origin of the left main coronary artery from the right sinus of Valsalva. The condition was accompanied by a slit ostium and an extramural stenosis of the left main coronary artery. Surgery was offered to the patient in view of his young age and the uncertain prospective course of the disease. Coronary unroofing was not indicated, due to the extramural location of the stenosis. With the patient under cardiopulmonary bypass, the stenotic segment of the left main coronary artery was transected outside the aorta, repaired by vein patch augmentation, and reimplanted directly into the left coronary sinus. The patient recovered uneventfully. A postoperative computed tomographic angiogram showed good patency of the reconstructed artery. We expect excellent longevity of the directly reimplanted coronary artery.
authors.affiliation: Department of Thoracic & Cardiovascular Surgery, Wonkwang University Hospital, Iksan, Chonbuk, Republic of Korea.
authors.forename: Mi Kyung
authors.initials: MK
authors.lastname: Lee
authors.forename: Jong Bum
authors.initials: JB
authors.lastname: Choi
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Kim
authors.forename: Kong Su
authors.initials: KS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D012092:Replantation; D012850:Sinus of Valsalva / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
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