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Open Access Highly Accessed Debate

Anomalous aortic origin of coronary arteries from the opposite sinus: A critical appraisal of risk

Josiah M Peñalver1, Ralph S Mosca2, Daniel Weitz3 and Colin KL Phoon1*

Author Affiliations

1 Division of Pediatric Cardiology, Department of Pediatrics, 160 East 32nd Street, L-3, New York, NY 10016, USA

2 Division of Pediatric and Adult Congenital Cardiac Surgery, Department of Cardiothoracic Surgery, 530 First Avenue, Suite 9-V, New York, NY 10016, USA

3 Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA

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BMC Cardiovascular Disorders 2012, 12:83  doi:10.1186/1471-2261-12-83

Published: 1 October 2012

Abstract

Background

Anomalous aortic origin of the coronary artery (AAOCA) from the opposite sinus of Valsalva with an interarterial course has received much attention due to its association with sudden death in otherwise healthy individuals. AAOCA is relatively common and may have significant public health implications. While our knowledge of its pathophysiology and natural history remains incomplete, an emphasis has been placed on surgical correction.

Discussion

In 2005 we published a review examining the rates of sudden death with AAOCA, as well as complications of surgical management. Evidence now points even more strongly to lower rates of sudden death, while surgical outcomes data now better documents associated risks.

Summary

Armed with this updated information, we agree with the need for a national registry to better track patients with AAOCA. We submit that the risks of surgical management outweigh any benefits in the asymptomatic patient with anomalous right coronary artery, and expectant management should also be strongly considered even in asymptomatic patients with anomalous left coronary artery.

Keywords:
Coronary artery anomaly; Sudden cardiac death; Anomalous aortic origin of the coronary artery; Heart defects; Congenital