Introduction
Anomalous aortic origin of coronary arteries (AAOCA) is a non-infrequent
congenital, anatomic heart anomaly whose prevalence in the population is
dramatically heightened in the last years [1-4].
The association with sudden cardiac death in athletes has improved the
medical awareness of this malformation leading to an increase in
cardiologic investigations, especially before competitive sport practice
[5].
Several studies have attempted to quantify this value, with estimates
ranging between 0.1 and 1% in both the adult and pediatric population.
Anomalous aortic origin of right coronary artery (AAORCA) is from three
to six times more frequent than anomalous aortic origin of left coronary
artery (AAOLCA), that is, on the other hand more commonly associated
with sudden cardiac death [6,7].
Surgical management of AAOCA continues to be a matter of debate
especially in asymptomatic AAORCA [8-10]. Several surgical
techniques have been developed in the last years with excellent results
in terms of mortality and freedom from re-operations. Although the
unroofing is the most used technique, neo-ostioplasty and coronary
reimplantation are effective and have showed comparable outcomes
[11-13]. Regardless of the technique used, is it the overall shape
and the normalization of the take-off angle the mainstay of surgical
management [13]. Also, unfortunately, there were some reports that
have showed symptoms recurrence after surgery [14,15].
The aim of the present study is to describe our surgical management in
AAOCA describing how an anatomic-based patient-specific approach is
associated with complete symptoms resolution at mid-term follow-up.