title: Surgical Correction of Aberrant Right Coronary Anomalies Stranding an Aortic Commissure with and Without Unroofing.
abstract: The technique for successful surgical correction of an anomalous origin of the right coronary artery from the opposite aortic cusp with an aberrant course between the aorta and pulmonary artery is illustrated in a symptomatic 62-year-old woman. The intramural course of the right coronary artery traversed the tip of the commissure between the anterior and posterior leaflets, and its repair entailed unroofing of the intramural segment from inside the aortic intima. This technique required resuspension of the overlying commissure to maintain optimal aortic valve leaflet coaptation and prevent aortic insufficiency. Modifications of this technique have been utilized by us whenever the intramural segment traversed behind the commissure. In these cases, partial or subtotal unroofing of the intramural segment was performed to preserve the integrity of the intima behind the overlying commissure. More recently, we have performed the surgical correction by probing the intramural segment within the aortic wall to its most anterior location and then performing a wide anterior unroofing in the aortic intima, and marsupializing the aortic and coronary intima to avoid dissection or intimal flap development. We favor utilizing these techniques of anatomic correction of the anomalous coronary to other techniques involving coronary artery bypass grafting of the anomalous coronary, especially in adult patients, as unroofing provides more lasting results.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA. khaled1@uic.edu.|Division of Cardiothoracic Surgery, University of Illinois at Chicago, 840 S. Wood St., CSB Suite 417 (MC 958), Chicago, IL, 60612, USA. khaled1@uic.edu.
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdelhady
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Samarth
authors.initials: S
authors.lastname: Durgam
authors.affiliation: Advocate Hope Children's Hospital, The Heart Institute for Children, Chicago, IL, USA.
authors.forename: Chawki
authors.initials: C
authors.lastname: Elzein
authors.affiliation: Advocate Hope Children's Hospital, The Heart Institute for Children, Chicago, IL, USA.
authors.forename: Michel N
authors.initials: MN
authors.lastname: Ilbawi
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rhoiney
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Malek G
authors.initials: MG
authors.lastname: Massad
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged
keywords: Aberrant coronary artery; Anomalous right coronary; Aortic commissure resuspension; Ostial transposition; Unroofing