PURPOSE: Unroofing of anomalous coronary artery originating from opposite sinus of Valsalva has become procedure of choice for this congenital lesion, with surgery performed in children as young as 2 years old. An increasing number of this anomaly is diagnosed in infancy with no clear indication for surgical repair. This paper reviews our experience with this anomaly, and focuses on its surgical management in infants.
METHODS: Between April 2002 and February 2007, 8 patients underwent surgical repair of anomalous coronary artery arising from opposite sinus of valsalva and coursing between aorta and pulmonary artery. Patients’ age varied from 2 months to 28 years with a mean of 11.7 ± 11.1 years. Surgical repair involved unroofing the intramural segment of anomalous coronary artery using cardiopulmonary bypass.
RESULTS: Two patients were younger than one year old (group A), and 6 patients were older than one year (group B). The mean intensive care unit stay was 2.5 ± 0.7 days for group A and 2.8 ± 1.9 for group B. The mean hospital stay was 4 ± 1.4 days for group A and 4.3 ± 2.4 days for group B. There were no complications nor mortality. The mean follow up period is 14 ± 15.7 months with a range of 1- 39 months. At the time of the last follow up, all patients were asymptomatic in NYHA class I and follow-up echocardiography on 6/8 patients showed wide open coronary ostium.
CONCLUSION: Unroofing anomalous coronary artery arising from opposite sinus of valsalva can be done in infants with minimal morbidity and mortality. Longer follow up is needed to assess long-term results.
CLINICAL IMPLICATIONS: Anomalous coronaries arising from the wrong sinus and coursing between aorta and pulmonary artery have been associated with sudden death. With improvement in echocardiographic imaging, more of these lesions are being diagnosed very early in infancy, raising the question of whether these patients should undergo surgery at an early age to prevent sudden death.
DISCLOSURE: Mehdi Akhavan-Heidari, No Financial Disclosure Information; No Product/Research Disclosure Information