title: Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk.
abstract: BACKGROUND
  Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has received much attention due to its association with sudden death in otherwise healthy individuals. AAOCA is relatively common and may have significant public health implications. While our knowledge of its pathophysiology and natural history remains incomplete, an emphasis has been placed on surgical correction.
  
  
  CONCLUSIONS
  In 2005 we published a review examining the rates of sudden death with AAOCA, as well as complications of surgical management. Evidence now points even more strongly to lower rates of sudden death, while surgical outcomes data now better documents associated risks.
  
  
  CONCLUSIONS
  Armed with this updated information, we agree with the need for a national registry to better track patients with AAOCA. We submit that the risks of surgical management outweigh any benefits in the asymptomatic patient with anomalous right coronary artery, and expectant management should also be strongly considered even in asymptomatic patients with anomalous left coronary artery.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, 160 East 32nd Street, L-3, New York, NY 10016, USA. colin.phoon@nyumc.org.
authors.forename: Josiah M
authors.initials: JM
authors.lastname: Peñalver
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.forename: Daniel
authors.initials: D
authors.lastname: Weitz
authors.forename: Colin K L
authors.initials: CK
authors.lastname: Phoon
mesh_terms: D058070:Asymptomatic Diseases; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012850:Sinus of Valsalva / Q000002:abnormalities* / Q000601:surgery; D016896:Treatment Outcome