Surgical Treatment of Anomalous Aortic Origin of Coronary Arteries: The Reimplantation Technique and Its Modifications

Although anomalous aortic origin of a coronary artery has been described as a benign anomaly in the past, several reports suggest that such an anomaly may be the cause of sudden death in children and younger adults. Increased cardiac output during exercise may result in compression of the anomalous coronary artery when it runs between the aorta and the pulmonary artery or when its aortic origin is narrowed and its proximal course is intramural. It is unlikely that this rare anomaly would be identified during infancy, but once diagnosis has been made, indication to proceed with surgery is controversial. Nevertheless, if surgery is recommended, several operative techniques may be used, depending on the specific anatomy; unroofing, direct reimplantation, patch enlargement, and even coronary artery bypass grafting have been proposed. In this short report, we focus on different techniques of coronary reimplantation. As we already know from the arterial switch operation in neonates and from aortic root repair or replacement in adults, sufficient mobilization is necessary to allow direct reimplantation in the correct sinus to avoid kinking and other distortion.