High-risk congenital coronary abnormalities in patients with bicuspid aortic valve

Abstract

Differences in coronary anatomy have been described in patients with bicuspid aortic valve (BAV), including abnormal coronary artery origin (ACAO). The objective of our study was to specify the prevalence of high-risk ACAO with inter arterial course in the BAV population. We retrospectively identified 279 consecutive patients with BAV who underwent elective aortic valve/root surgery in the cardiac surgery unit of the Caen University Hospital Center between 2010 and 2019. After reviewing the medical and surgical reports, we identified those with the associated high-risk ACAO. The ACAO should be associated with an inter-arterial course pre-operatively identified by invasive coronary angiography and/or computed tomography scan, and confirmed by the intra operative description. The final decision on BAV diagnosis and type (defined according to the classification of Sievers) was made based on the intraoperative description. Overall, 4 patients (prevalence: 1.4%) were identified with ACAO with inter arterial course ( Fig. 1 ). Three patients had abnormal right coronary artery arising from the theoretical left coronary sinus. Among them one had a type 1 Right-Left BAV, a second had a type 1 left-non coronary BAV and the third had a type 2 BAV. The fourth patient presented a left coronary artery from a single coronary artery arising from the theoretical right coronary sinus, associated with a type 1 Right-Left BAV. None of them had history of arrhythmia, chest pain neither syncope. High-risk ACA0 are more prevalent in patients with BAV, regardless of cusp-fusion type, and should always be considered when diagnosing this frequent congenital valvulopathy.