title: Repair of anomalous aortic origin of a coronary artery in 113 patients: a Congenital Heart Surgeons' Society report.
abstract: BACKGROUND
  Anomalous aortic origin of a coronary artery (AAOCA) encompasses a wide morphologic spectrum, which has impeded consensus regarding indications for the diverse repair strategies. We constructed a profile of current surgical techniques and explore their application to morphologic variants.
  
  
  METHODS
  Patients<30 years old (n=113) with isolated AAOCA who underwent operations at 29 Congenital Heart Surgeons Society (CHSS) institutions from 1998 to 2012 were identified from the CHSS AAOCA Registry. Operative findings were related to surgical techniques at index repairs by cross-tabulation.
  
  
  RESULTS
  Anomalous origin of the left main or left anterior descending coronary artery was present in 33 (29%) patients and of the right coronary artery in 78 (69%) patients; 2 arteries originated directly above the commissure between the left and right sinuses. There were 101 (89%) interarterial and intramural (IA/IM) arteries, 10 (9%) were interarterial but not intramural (IA/NIM) and 2 (2%) were neither interarterial nor intramural. Intramural arteries were unroofed in 100 (88%) operations, usually with intimal tacking after incision (n=47) or excision (n=25) of the common wall. Coronary reimplantation (n=11), pulmonary artery relocation (n=7; 5 for IA/NIM), simple ostioplasty (without unroofing; n=3), coronary artery bypass grafting (n=2), and ostial window (n=1) were less common. In 37 (33%) operations, a valvar commissure was taken down; 33 were resuspended.
  
  
  CONCLUSIONS
  Current surgical repair of AAOCA is individualized to morphology, particularly the presence of intramural and/or interarterial segments. This report is foundational for future planned CHSS studies that will examine interventional and noninterventional outcomes and ultimately guide management of AAOCA.
authors.affiliation: Congenital Heart Surgeons Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Poynter
authors.affiliation: Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Igor
authors.initials: I
authors.lastname: Bondarenko
authors.affiliation: Kosair Children's Hospital, University of Louisville, Louisville, KY, USA.
authors.forename: Erle H
authors.initials: EH
authors.lastname: Austin
authors.affiliation: Department of Cardiothoracic Surgery, Arnold Palmer Hospital for Children, Orlando, FL, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: DeCampli
authors.affiliation: Johns Hopkins All Children's Heart Institute, Johns Hopkins University, All Children's Hospital, St Petersburg, FL, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Department of Surgery, University of Chicago, Chicago, IL, USA.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ziemer
authors.affiliation: Cardiothoracic Surgery, Yale University, New Haven, CT, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
authors.affiliation: Montreal Children's Hospital, Montreal, PQ, Canada.
authors.forename: Christo I
authors.initials: CI
authors.lastname: Tchervenkov
authors.affiliation: Department of Pediatric Cardiac Surgery, University of California-San Francisco Benioff Children's Hospital, San Francisco, CA, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: Henry L
authors.initials: HL
authors.lastname: Walters
authors.affiliation: Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Mery
authors.affiliation: Glendale Department of Childhealth, University of Arizona College of Medicine, Phoenix, AZ, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pearl
authors.affiliation: Pediatric Cardiac Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Brothers
authors.affiliation: Division of Cardiac Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.affiliation: Congenital Heart Surgeons Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.affiliation: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.affiliation: Johns Hopkins University, Florida Hospital for Children, Orlando, FL, USA constantine.mavroudis.md@flhosp.org.
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D012042:Registries
keywords: congenital heart disease; congenital heart surgery; coronary artery anomaly; myocardial morphology