Anomalous Aortic Origin of Coronary Arteries in Children: Postoperative High-risk Anatomic Features.

Autor:	Doan TT; Coronary Artery Anomalies Program, Section of Cardiology, Texas Children's Hospital, Houston, Texas. Electronic address: tam.doan@bcm.edu., Sachdeva S; Coronary Artery Anomalies Program, Section of Cardiology, Texas Children's Hospital, Houston, Texas., Bonilla-Ramirez C; Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas., Reaves-O'Neal D; Coronary Artery Anomalies Program, Section of Cardiology, Texas Children's Hospital, Houston, Texas., Masand P; Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas., Krishnamurthy R; Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio., Jadhav S; Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas., Mery CM; Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children's Medical Center, The University of Texas at Austin, Austin, Texas., Binsalamah Z; Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas., Molossi S; Coronary Artery Anomalies Program, Section of Cardiology, Texas Children's Hospital, Houston, Texas.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2023 Apr; Vol. 115 (4), pp. 991-998. Date of Electronic Publication: 2022 Dec 05.
DOI:	10.1016/j.athoracsur.2022.11.024
Abstrakt:	Background: This study aimed to assess postoperative presumed high-risk anatomic features (HRAFs) by using computed tomographic angiography (CTA) in patients with anomalous aortic origin of a coronary artery (AAOCA) after surgical unroofing vs transection and reimplantation (TAR) if unroofing was thought to provide unsatisfactory results. Methods: The study included 62 children with postoperative CTA performed at a median of 3 months (interquartile range, 3-4 months) after unroofing (n = 45) and TAR (n = 17). HRAFs included slitlike ostium, intramural course, acute angle takeoff (<45 o ), interarterial course, proximal stenosis >50%, or course through a thickened intercoronary pillar. Results: Median age at surgery was 13.8 years (interquartile range, 10.5-15.8 years). None of the patients had a slitlike ostium or an intramural course on postoperative CTA. Acute takeoff was seen in 100% after unroofing and in 2 of 17 (12%) after TAR (P < .001). After unroofing, the interarterial course improved to 35 of 45 (78%) from 43 of 45 (96%) (P = .003), and a thickened intercoronary pillar improved to 10 of 45 (22%) from 22 of 45 (49%) (P = .0001), compared with none seen after TAR. Preoperative intramural length <5 mm was associated with a postoperative thickened intercoronary pillar in right AAOCA after unroofing (P = .0004). Severe coronary stenosis occurred in 2 of 17 (12%) after TAR, and both patients needed urgent revision procedures. All patients except 2 (97%) returned to exercise activities at a median follow-up of 4.9 years (range, 0.6-9.2 years). Conclusions: The slitlike ostium and intramural course resolved in all patients. Residual acute angle takeoff, an interarterial course, and mild coronary narrowing related to a thickened intercoronary pillar were common after unroofing. TAR allows resolution of all HRAFs, although severe narrowing requiring surgical revision happened only in TAR. Long-term studies are needed to understand the clinical significance of these residual presumed HRAFs. (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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