Ostial Patch Plasty of an Aberrant Right Coronary Artery in a Symptomatic Teenager
AbstractAn otherwise healthy 15-year-old girl presented with a history of transient myocardial ischemia. At the time, troponin levels were elevated to 20 ?g/L. A myocardial perfusion scintigraphy evaluation revealed a minor scarring with an irreversible inferior defect at rest and at exercise. On admission, the patient was free from symptoms. Transthoracic echocardiography and computer tomography examinations revealed an aberrant origin of the right coronary artery (RCA) from the left sinus of Valsalva, just below the commissure. Repair was accomplished by incision into the RCA and patch plasty. An anomalous aortic origin of a coronary artery from the incorrect coronary sinus of Valsalva is a rare congenital cardiac defect that is associated with an increased risk of sudden death and cardiac morbidity; however, ischemia can occur even when the patient remains asymptomatic. Although this anomalous artery often shares a common orifice with the other coronary artery, it did not in the reported case. In conclusion, because of the high risk of sudden cardiac death, aggressive surgical management is indicated in symptomatic patients.
Cheitlin MD, DeCastro CM, McAllister HA. 1974. Sudden death as the complication of anomalous left coronary origin from the anterior sinus of Valsalva. Circulation 50:780-7.nDavis JA, Cecchin F, Jones TK, Portman MA. 2001. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol 37:593-7.nJaggers J, Pal J. 2008. Surgical therapy for anomalous aortic origin of the coronary arteries. Oper Tech Thorac Cardiovasc Surg 13:26-34.nMaron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. 1996. Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA 276:199-204.nYamanaka O, Hobbs RE. 1990. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn 21:28-40.n
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