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Nellis JR, Drysdale ND, Evans MA, Habermann AC, Meza JM, Andersen ND, Daneshmand MA, Turek JW. Anomalous Aortic Origin of a Coronary Artery Repair Through an Anterior Minithoracotomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:480-484. [PMID: 34338072 DOI: 10.1177/15569845211031541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The benefits of minimally invasive adult cardiac surgery are well established. Nevertheless, minimally invasive congenital cardiac procedures, even for adult patients, are uncommon. In 2018, we started repairing anomalous aortic origin of a coronary artery (AAOCA) through a 5 cm anterior minithoracotomy when possible to improve cosmesis and avoid sternal precautions. We hypothesized this approach was safe and reliable. METHODS A 5 cm incision was made in the right second intercostal space. The incision was carried down to the pericardium while preserving the internal mammary artery. With the pericardium in view, the second and third ribs were disarticulated. Central cardiopulmonary bypass was established, and the repair was carried out based on the patient's anatomy. The technique was modified to a left anterior minithoracotomy for 1 patient who required pulmonary artery translocation. At any point, if the dissection or repair was not progressing appropriately, the minimally invasive exposure was converted to a partial or traditional median sternotomy. RESULTS Between June 2018 and June 2019, 11 patients underwent minimally invasive anomalous coronary repair. Four patients (3 with body mass index >30) were converted to traditional sternotomy due to poor visualization. Postoperatively, 1 patient required coronary artery bypass after 335 days, due to extensive collaterals and stable angina. Otherwise, at a median follow-up of 437 days (IQR 340 to 480), patients had resumed baseline activity without recurrent symptoms. CONCLUSIONS Minimally invasive AAOCA repair may be appealing, although surgeons should be cautious given the high conversion rate.
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Affiliation(s)
- Joseph R Nellis
- 3065 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Nicolas D Drysdale
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Megan A Evans
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - Alyssa C Habermann
- Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA
| | - James M Meza
- 3065 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA
| | - Nicholas D Andersen
- 3065 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA.,Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
| | - Mani A Daneshmand
- 22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA
| | - Joseph W Turek
- 3065 Department of Surgery, Duke University Hospitals, Durham, NC, USA.,Duke Congenital Heart Surgery Research & Training Laboratory, Durham, NC, USA.,22957 Division of Cardiothoracic Surgery, Duke University Hospitals, Durham, NC, USA.,Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NC, USA
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Hinton ZW, Meza JM, Habermann AC, Andersen ND, Daneshmand MA, Turek JW. Right Anterior Mini-Incision Approach to Anomalous Right Coronary Artery Repair. World J Pediatr Congenit Heart Surg 2020; 11:215-216. [DOI: 10.1177/2150135119892928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The right anterior mini-incision has emerged as an effective minimally invasive approach for adult aortic root and valve operations. However, adoption of minimally invasive techniques has been limited in congenital heart surgery. We report a case of anomalous aortic origin of the right coronary artery repair performed through this approach. Following successful right coronary artery unroofing, the patient had an uncomplicated postoperative hospitalization.
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Affiliation(s)
- Zoe W. Hinton
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
| | - James M. Meza
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Alyssa C. Habermann
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
| | - Nicholas D. Andersen
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Mani A. Daneshmand
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, GA, USA
| | - Joseph W. Turek
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
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Matsumura K, Matsumoto H, Hata Y, Ueyama T, Kinoshita T, Kuwauchi S, Takami Y, Kawazoe K, Shiojima I. Anomalous Right Coronary Artery Arising from the Left Sinus of Valsalva in a Young Athlete. Intern Med 2016; 55:55-8. [PMID: 26726086 DOI: 10.2169/internalmedicine.55.5511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cardiac events associated with congenital coronary abnormalities are rare but potentially life-threatening in a young population. Most of these patients are not diagnosed before their initial cardiac event. Amongst such coronary artery anomalies, sudden death is frequently seen in an anomalous origination of a coronary artery from the opposite sinus. We herein present the case of a patient who presented with sudden cardiac arrest associated with an anomalous right coronary artery originating from the left sinus of Valsalva. Surgical treatment was selected because there was evidence of reversible ischemia based on the findings of a stress test.
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