Successful neo-ostium creation using pulmonary artery tissue in a case of anomalous origin of the left coronary artery from the right sinus of Valsalva

Abstract

Anomalous origin of the left coronary artery (LCA) from the right sinus of Valsalva is rare and is known to cause sudden death in young patients. A 17-year old male patient experienced syncopal episodes after intense exercise. No abnormal findings were noted on brain magnetic resonance imaging, electroencephalography or Holter monitoring. Contrast-enhanced coronary computed tomography revealed the anomalous origin of the LCA from the right sinus of Valsalva. Considering the positional relationship with the aortic valve and the morphology of the left main trunk, a neo-ostium was created in the left coronary sinus, and patch angioplasty was performed using pulmonary arterial wall tissue. The postoperative course of the patient was uneventful, and the patient remains asymptomatic 2 years after surgery. Here, we describe this case and review the literature on the different surgical techniques for this anomaly. We believe that our technique would be useful in cases of anomalous origin of the LCA from the right sinus of Valsalva, regardless of morphological variations.