Abstract
BackgroundAnomalous 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.DiscussionIn 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.SummaryArmed 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.
Highlights
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
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 be strongly considered even in asymptomatic patients with anomalous left coronary artery
Summary
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. Anomalous aortic origin of the coronary artery arising from the opposite sinus (AAOCA) has received much attention due to its association with sudden cardiac death (SCD). It is believed to be relatively common and is a potentially serious public health hazard. The goals of this paper are three-fold: 1) to review briefly the diagnosis and presumed pathophysiology of AAOCA; 2) to show recent data supporting our argument that the risk of SCD is far lower than many believe; and 3) to analyze recent surgical data, which cast serious
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