Transcatheter Intervention for Treatment of Coronary Stenosis After Unroofing of the Anomalous Left Coronary Artery
Anomalous origin of left coronary artery (LCA) from the right coronary cusp with an intramural course is usually managed with unroofing of the intramural segment. Available literature demonstrates an uneventful course following surgery in most patients. Coronary stenosis following the unroofing procedure treated with percutaneous coronary intervention has not been described in the past. We describe a case where an 11-year-old girl with anomalous origin of the LCA from the right coronary cusp presented with near syncope. Surgical unroofing of the intramural segment was done without any post-operative complications and the patient remained asymptomatic for 9 months. She then presented with chest pain, abnormal troponin levels, and ST-T wave changes on EKG. A CT angiogram done revealed short segment narrowing of the LCA near its origin. Cardiac catheterization with coronary angiography demonstrated short segment narrowing of the LCA just distal to origin. Stenting of the left main coronary artery was done with a drug eluting stent. She underwent the procedure without complications. The patient continued to be asymptomatic 16 months after placement of the stent and there was no residual stenosis seen on a repeat CT angiogram at 3 months after the procedure.
KeywordsCoronary vessel anomalies Coronary angiography Drug eluting stent Congenital heart disease pediatric
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and was approved by the Institutional Review Board, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.Cheezum MK, Ghoshhajra B, Bittencourt MS, Hulten EA, Bhatt A, Mousavi N, Shah NR, Valente AM, Rybicki FJ, Steigner M, Hainer J, MacGillivray T, Hoffmann U, Abbara S, Di Carli MF, DeFaria Yeh D, Landzberg M, Liberthson R, Blankstein R (2017) Anomalous origin of the coronary artery arising from the opposite sinus: prevalence and outcomes in patients undergoing coronary CTA. Eur Heart J Cardiovasc Imaging 18(2):224–235. https://doi.org/10.1093/ehjci/jev323 CrossRefGoogle Scholar
- 2.Thankavel PP, Lemler MS, Ramaciotti C (2015) Utility and importance of new echocardiographic screening methods in diagnosis of anomalous coronary origins in the pediatric population: assessment of quality improvement. Pediatr Cardiol 36(1):120–125. https://doi.org/10.1007/s00246-014-0973-8 CrossRefGoogle Scholar
- 4.Mery CM, De León LE, Molossi S, Sexson-Tejtel SK, Agrawal H, Krishnamurthy R, Masand P, Qureshi AM, McKenzie ED, Fraser CD (2018) Outcomes of surgical intervention for anomalous aortic origin of a coronary artery: a large contemporary prospective cohort study. J Thorac Cardiovasc Surg 155(1):305–319. e304CrossRefGoogle Scholar
- 5.Sharma V, Burkhart HM, Dearani JA, Suri RM, Daly RC, Park SJ, Horner JM, Phillips SD, Schaff HV (2014) Surgical unroofing of anomalous aortic origin of a coronary artery: a single-center experience. Ann Thorac Surg 98(3):941–945. https://doi.org/10.1016/j.athoracsur.2014.04.114 CrossRefGoogle Scholar
- 6.Sachdeva S, Frommelt MA, Mitchell ME, Tweddell JS, Frommelt PC (2018) Surgical unroofing of intramural anomalous aortic origin of a coronary artery in pediatric patients: Single-center perspective. J Thorac Cardiovasc Surg 155(4):1760–1768. https://doi.org/10.1016/j.jtcvs.2017.11.003 CrossRefGoogle Scholar
- 7.Angelini P (2002) Coronary artery anomalies—current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Texas Heart Inst J 29(4):271–278Google Scholar
- 8.Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Page RL, Riegel B, Tarkington LG, Yancy CW (2008) ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(23):e143–e263. https://doi.org/10.1016/j.jacc.2008.10.001 CrossRefGoogle Scholar
- 11.Brothers JA, McBride MG, Seliem MA, Marino BS, Tomlinson RS, Pampaloni MH, Gaynor JW, Spray TL, Paridon SM (2007) Evaluation of myocardial ischemia after surgical repair of anomalous aortic origin of a coronary artery in a series of pediatric patients. J Am Coll Cardiol 50(21):2078–2082. https://doi.org/10.1016/j.jacc.2007.06.055 CrossRefGoogle Scholar
- 12.Frommelt PC, Sheridan DC, Berger S, Frommelt MA, Tweddell JS (2011) Ten-year experience with surgical unroofing of anomalous aortic origin of a coronary artery from the opposite sinus with an interarterial course. J Thorac Cardiovasc Surg 142(5):1046–1051. https://doi.org/10.1016/j.jtcvs.2011.02.004 CrossRefGoogle Scholar