Reply to Kaleda

Abstract

We thank Dr Kaleda for his commentary [1] on our recent publication [2]. We appreciate his valid observation that mixed two different classifications: one related to single coronary artery [3] and the other related to dual left anterior descending coronary [4]. Angelini et al. [5] suggested a new classification that instead of alphabetical–numerical listings (as R-IIIC type, Type IV dual LAD), preferred to be more descriptive, using clear terminology that identifies each anomaly. Moreover, Angelini preferred to combine the traditional headings ‘anomalies of origin’ and ‘anomalies of course’ in one classification group, because the proximal course of a coronary artery can only be abnormal if the origin of the artery is abnormal (except in the case of intramural or subendocardial coronary arteries) [4]. Recently, Sithamparanathan et al. [6] suggested that previous classifications [3, 4] are limited to invasive angiography and not transferable for use with other imaging modalities. Additionally, they are not applicable to patients with congenital heart disease. For all these reasons, Sithamparanathan et al. have proposed a new descriptive and alphanumeric classification for the complete delineation of coronary anatomy and great vessels. However this new classification needs to be clinically validated in the near future [6]. In our recent publication [2], the coronary anomaly was correlated with a single coronary ostium and the left circumflex artery presented a retroaortic path and partly supplied the proximal portion of the anterior interventricular sulcus. This anatomical pattern did not contraindicate a conventional surgical approach to the aortic valve. It is important to recognize preoperatively coronary anomalies in order to understand the pathophysiological mechanisms that could be potentially lethal during cardiac surgery. For this reason, we consider that any classification should be clinically oriented [5].