ABSTRACT
INTRODUCTION: Anomalous aortic origin of coronary artery (AAOCA) is the second leading cause of sudden cardiac death in children and young adults. Intramural-interarterial course is the most frequent anatomic variation and coronary unroofing is widest adopted for surgical management. Symptoms recurrence is described regardless of the technique used. This study aims to describe how an anatomic patient-centered approach aimed to restore a normal coronary artery take-off is associated with symptoms resolution. METHODS: From 2008 to 2021, 25 patients were operated on for an AAOCA at a median age of 20 years. Nineteen patients had a right AAOCA and six had left AAOCA. Intramural course was present in 18 patients. Seventy-six percent were symptomatic. No episodes of aborted sudden cardiac death before surgery was described in the population. Surgical technique used were coronary unroofing in 18 patients, coronary neo-ostioplasty in 3, coronary Reimplantation in 3, and main pulmonary artery re-location in 1. RESULTS: No hospital mortality or reoperation was observed in our experience as well as major complications related to surgery. Mean hospital length of stay was 8.5 days. None of patients reported symptoms recurrence at follow-up. Young athletes returned to play competitive sport. Postoperative computed tomography scan evaluation showed a general improvement of the take-off angle. CONCLUSIONS: AAOCA requires a patient anatomic-based surgical management. There is not a single surgical technique that can fits all anatomic subtype of AAOCA. Surgical techniques may be selected on the base of the preoperative images and intraoperative findings. In our experience, this policy is associated with no symptoms recurrence.
Subject(s)
Coronary Vessel Anomalies , Coronary Vessels , Adult , Aorta, Thoracic/surgery , Child , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Death, Sudden, Cardiac , Humans , Retrospective Studies , Young AdultSubject(s)
Cardiac Valve Annuloplasty , Extracellular Matrix/transplantation , Heart Valve Diseases/surgery , Heart Valves , Postoperative Complications , Cardiac Valve Annuloplasty/instrumentation , Cardiac Valve Annuloplasty/methods , Child , Child Development , Echocardiography , Heart Valves/growth & development , Heart Valves/surgery , Humans , Monitoring, Physiologic/methods , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Time , Transplantation, HeterologousABSTRACT
Congenital heart diseases are corrected early in life, so the surgical procedure has to maintain the maximum potential for growth. The quest for the ideal material for cardiac tissue repair is still ongoing. Here, we describe our preliminary experience with an extracellular matrix for cardiac and vascular tissue repair. Between August 2009 and April 2011, 26 patients underwent cardiac surgery using the CorMatrix patch for vascular repair (10 pulmonary artery, four ascending aorta, three aortic arch and one right ventricular outflow tract) or for valve reconstruction (five aortic, two tricuspid, one mitral and one pulmonary valve); in four cases, the repair was associated with pericardial closure using the same patch. There were no deaths, and at a mean follow-up of 13.2 months, there was no evidence of patch-related complications either in the vascular position or when used for valve repair. The ideal material for cardiac tissue repair should be haemostatic and resistant to tearing and calcification, and possibly one that will not induce an inflammatory cascade. In the last 25 months, we used an extracellular matrix for cardiac and vascular tissue repair. The patch is advocated to induce the patient's own tissue regeneration. The early results are encouraging, but a longer follow-up is needed to understand the real potential of this material.
