Debate

BMC Cardiovascular Disorders

, 12:83

Open Access This content is freely available online to anyone, anywhere at any time.

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

  • Josiah M PeñalverAffiliated withDivision of Pediatric Cardiology, Department of Pediatrics
  • , Ralph S MoscaAffiliated withDivision of Pediatric and Adult Congenital Cardiac Surgery, Department of Cardiothoracic Surgery
  • , Daniel WeitzAffiliated withLeon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
  • , Colin KL PhoonAffiliated withDivision of Pediatric Cardiology, Department of Pediatrics Email author 

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