Individualized surgical treatment strategy for children with anomalous aortic origin of coronary artery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Kai ,  ZHENG Jinghao , ZHANG Wei , ZHU Zhongqun , PAN Yanjun , HE Xiaomin , SUN Qi

Heart Center, Shanghai Children's Medical Center Affiliated to the Medical School of Shanghai Jiao Tong University, Shanghai, 200127, P. R. China;

Corresponding author：

ZHENG Jinghao, Email: zhengjh210@163.com

Keywords：

Anomalous aortic origin of coronary artery; myocardial ischemia; individualized surgical treatment strategy

DOI：

10.7507/1007-4848.202205026

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Objective To summarize and explore the individualized surgical treatment strategy and prognosis of anomalous aortic origin of coronary artery (AAOCA). Methods The clinical data of children with AAOCA admitted to Shanghai Children's Medical Center from March 2018 to August 2021 were retrospectively analyzed. Results A total of 17 children were enrolled, including 13 males and 4 females, with a median age of 88 (44, 138) months and a median weight of 25 (18, 29) kg. All patients received operations. The methods of coronary artery management included coronary artery decapitation in 9 patients, coronary artery transplantation in 5 patients and coronary artery perforation in 3 patients. One patient with severe cardiac insufficiency (left ventricular ejection fraction 15%) received mechanical circulatory assistance after the operation for 12 days. No death occurred in the early postoperative period, the average ICU stay time was 4.3±3.0 d, and the total hospital stay was 14.4±6.1 d. All the children received regular anticoagulation therapy for 3 months after discharge. The median follow-up time was 15 (13, 24) months. All patients received regular anticoagulation therapy for 3 months after discharge. No clinical symptoms such as chest pain and syncope occurred again. The cardiac function grade was significantly improved compared with that before operation. Imaging examination showed that the coronary artery blood flow on the operation side was unobstructed, and no restenosis occurred. Conclusion AAOCA is easy to induce myocardial ischemia and even sudden cardiac death. Once diagnosed, operation should be carried out as soon as possible. According to the anatomic characteristics of coronary artery, the early effect of individualized surgery is satisfactory, and the symptoms of the children are significantly improved and the cardiac function recovers well in the mid-term follow-up.

Citation： LUO Kai, ZHENG Jinghao, ZHANG Wei, ZHU Zhongqun, PAN Yanjun, HE Xiaomin, SUN Qi. Individualized surgical treatment strategy for children with anomalous aortic origin of coronary artery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 263-268. doi: 10.7507/1007-4848.202205026 Copy

1.	Rahmouni K, Bernier PL. Current management of anomalous aortic origin of a coronary artery: A Pan-Canadian survey. World J Pediatr Congenit Heart Surg, 2021, 12(3): 387-393.
2.	Agrawal H, Mery CM, Day PE, et al. Current practices are variable in the evaluation and management of patients with anomalous aortic origin of a coronary artery: Results of a survey. Congenit Heart Dis, 2017, 12(5): 610-614.
3.	Molossi S, Martínez-Bravo LE, Mery CM. Anomalous aortic origin of a coronary artery. Methodist Debakey Cardiovasc J, 2019, 15(2): 111-121.
4.	Vouhé PR. Anomalous aortic origin of a coronary artery is always a surgical disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2016, 19(1): 25-29.
5.	Mosca RS, Phoon CK. Anomalous aortic origin of a coronary artery is not always a surgical disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2016, 19(1): 30-36.
6.	Agrawal H, Mery CM, Sami SA, et al. Decreased quality of life in children with anomalous aortic origin of a coronary artery. World J Pediatr Congenit Heart Surg, 2021, 12(2): 204-210.
7.	Adam EL, Generoso G, Bittencourt MS. Anomalous coronary arteries: When to follow-up, risk stratify, and plan intervention. Curr Cardiol Rep, 2021, 23(8): 102.
8.	Padalino MA, Franchetti N, Sarris GE, et al. Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. Int J Cardiol, 2019, 291: 189-193.
9.	Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2019, 73(12): 1494-1563.
10.	Cheezum MK, Liberthson RR, Shah NR, et al. Anomalous aortic origin of a coronary artery from the inappropriate sinus of valsalva. J Am Coll Cardiol, 2017, 69(12): 1592-1608.
11.	Jaggers J, Lodge AJ. Surgical therapy for anomalous aortic origin of the coronary arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2005: 122-7.
12.	Schubert SA, Kron IL. Surgical unroofing for anomalous aortic origin of coronary arteries. Operat Techniq Thorac Cardiovasc Surg, 2016, 21(3): 162-177.
13.	Bonilla-Ramirez C, Molossi S, Sachdeva S, et al. Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation. J Thorac Cardiovasc Surg, 2021, 162(4): 1191-1199.
14.	Padalino MA, Jegatheeswaran A, Blitzer D, et al. Surgery for anomalous aortic origin of coronary arteries: Technical safeguards and pitfalls. Front Cardiovasc Med, 2021, 8: 626108.

1. Rahmouni K, Bernier PL. Current management of anomalous aortic origin of a coronary artery: A Pan-Canadian survey. World J Pediatr Congenit Heart Surg, 2021, 12(3): 387-393.
2. Agrawal H, Mery CM, Day PE, et al. Current practices are variable in the evaluation and management of patients with anomalous aortic origin of a coronary artery: Results of a survey. Congenit Heart Dis, 2017, 12(5): 610-614.
3. Molossi S, Martínez-Bravo LE, Mery CM. Anomalous aortic origin of a coronary artery. Methodist Debakey Cardiovasc J, 2019, 15(2): 111-121.
4. Vouhé PR. Anomalous aortic origin of a coronary artery is always a surgical disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2016, 19(1): 25-29.
5. Mosca RS, Phoon CK. Anomalous aortic origin of a coronary artery is not always a surgical disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2016, 19(1): 30-36.
6. Agrawal H, Mery CM, Sami SA, et al. Decreased quality of life in children with anomalous aortic origin of a coronary artery. World J Pediatr Congenit Heart Surg, 2021, 12(2): 204-210.
7. Adam EL, Generoso G, Bittencourt MS. Anomalous coronary arteries: When to follow-up, risk stratify, and plan intervention. Curr Cardiol Rep, 2021, 23(8): 102.
8. Padalino MA, Franchetti N, Sarris GE, et al. Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. Int J Cardiol, 2019, 291: 189-193.
9. Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2019, 73(12): 1494-1563.
10. Cheezum MK, Liberthson RR, Shah NR, et al. Anomalous aortic origin of a coronary artery from the inappropriate sinus of valsalva. J Am Coll Cardiol, 2017, 69(12): 1592-1608.
11. Jaggers J, Lodge AJ. Surgical therapy for anomalous aortic origin of the coronary arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2005: 122-7.
12. Schubert SA, Kron IL. Surgical unroofing for anomalous aortic origin of coronary arteries. Operat Techniq Thorac Cardiovasc Surg, 2016, 21(3): 162-177.
13. Bonilla-Ramirez C, Molossi S, Sachdeva S, et al. Outcomes in anomalous aortic origin of a coronary artery after surgical reimplantation. J Thorac Cardiovasc Surg, 2021, 162(4): 1191-1199.
14. Padalino MA, Jegatheeswaran A, Blitzer D, et al. Surgery for anomalous aortic origin of coronary arteries: Technical safeguards and pitfalls. Front Cardiovasc Med, 2021, 8: 626108.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Individualized surgical treatment strategy for children with anomalous aortic origin of coronary artery

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