title: Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients.
abstract: BACKGROUND
  Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect that has been associated with myocardial ischemia and sudden death. Controversies exist regarding the diagnosis, treatment, and long-term recommendations for patients with AAOCA. The purpose of this study is to evaluate the medium-term results of surgical repair for AAOCA.
  
  
  METHODS
  From January 1999 through August 2010, 50 patients underwent surgical repair of AAOCA. The median age at surgery was 14 years (range, 5 days to 47 years). Thirty-one patients had the right coronary originate from the left sinus of Valsalva, 17 had the left coronary originate from the right sinus, and 2 had an eccentric single coronary ostium. Twenty six of the 50 patients had symptoms of myocardial ischemia preoperatively, and 14 patients had associated congenital heart defects. Repair was accomplished by unroofing in 35, reimplantation in 6, and pulmonary artery translocation in 9.
  
  
  RESULTS
  There was no operative mortality. The median time of follow-up has been 5.7 years. Two patients were lost to follow-up, and 1 patient required heart transplantation 1 year after AAOCA repair. In the remaining 47 postoperative patients, all have remained free of cardiac symptoms and no one has experienced a sudden death event.
  
  
  CONCLUSIONS
  The surgical treatment of AAOCA is safe and appears to be highly effective in eliminating ischemic symptoms. These medium-term results are encouraging and suggest that many patients may be able to resume normal activities.
authors: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California 94305, USA. mainwaring@stanford.edu
authors: Richard D
authors: RD
authors: Mainwaring
authors: V Mohan
authors: VM
authors: Reddy
authors: Olaf
authors: O
authors: Reinhartz
authors: Ed
authors: E
authors: Petrossian
authors: Malcolm
authors: M
authors: MacDonald
authors: Teimour
authors: T
authors: Nasirov
authors: Christina Y
authors: CY
authors: Miyake
authors: Frank L
authors: FL
authors: Hanley
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000151:congenital / Q000601:surgery; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult