Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course
Peter C. Frommelt, MD, FACC*,*,
Michele A. Frommelt, MD, FACC*,
James S. Tweddell, MD and
Robert D. B. Jaquiss, MD
* Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Department of Cardiothoracic Surgery, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
View larger version (36K):
[in a new window]
|
Figure 1 Transthoracic echocardiography from a short-axis plane in a patient with anomalous origin of the right coronary artery from the left sinus of Valsalva and an intramural course of the anomalous coronary. The anomalous right coronary artery can be seen arising from the left sinus of Valsalva (A) near the origin of the left main coronary artery (LMCA) and coursing intramurally within the anterior aortic wall (small arrows) between the aorta (Ao) and the pulmonary artery (PA) towards the right sinus of Valsalva. Color Doppler imaging (B) shows the linear diastolic flow of the anomalous coronary within the anterior aortic wall (arrow); the red color signal confirms anomalous coronary flow towards the transducer anteriorly, consistent with the coronary originating from the left sinus and coursing towards the more anteriorly positioned right sinus. For the accompanying videos corresponding to Figure 1 (Videos 1 and 2), please see the July 2 issue of JACC at www.cardiosource.com/jacc.html.
|
|
View larger version (54K):
[in a new window]
|
Figure 2 Transthoracic echocardiography from a short-axis plane in a patient with anomalous origin of the left coronary artery from the right sinus of Valsalva and an intramural course of the anomalous coronary. The two-dimensional image (A) shows the anomalous left main coronary artery running intramurally within the anterior aortic wall (small arrows) between the aorta (Ao) and pulmonary artery (PA) before exiting the wall in the left sinus of Valsalva and giving rise to the left anterior descending coronary branch (LAD). Color Doppler imaging (B) shows the linear diastolic flow of the anomalous coronary within the anterior aortic wall (arrow); the blue color signal confirms anomalous coronary flow away from the transducer, consistent with the coronary originating from the right sinus and coursing towards the more posteriorly positioned left sinus. After surgical unroofing of the intramural segment (C), a large neo-orifice has been created in the left sinus (arrow) giving rise to the left coronary system. For the accompanying videos corresponding to Figure 2 (Videos 3 and 4), please see the July 2 issue of JACC at www.cardiosource.com/jacc.html.
|
|
View larger version (89K):
[in a new window]
|
Figure 3 Transthoracic echocardiography in a patient with anomalous origin of the left coronary artery from the right sinus of Valsalva and an intramyocardial course of the anomalous coronary from a short-axis plane. The anomalous left coronary artery can be seen coursing between the aorta (Ao) and right ventricular outflow tract (RVOT) within the myocardial wall (arrows) before bifurcating into the left anterior descending (LAD) and circumflex (Cx) branches.
|
|
View larger version (29K):
[in a new window]
|
Figure 4 Diagram showing the unroofing technique in a patient with anomalous origin of the left coronary artery from the right sinus of Valsalva with an intramural course. The normally positioned right coronary artery orifice and the anomalous left coronary artery orifice can both be seen arising from the right sinus (A). The intramural segment of the anomalous coronary is unroofed (B) to create a neo-orifice in the left sinus (C). The base of the commissure between the right and left cusps is sometimes involved in the unroofing procedure, requiring resuspension (C).
|
|
|
