Background
An aberrant coronary artery is a rare clinical occurrence with an incidence of 0.05–1.2%.
Often it is an incidental finding detected on coronary angiography or at autopsy.
However, symptomatic patients can experience angina, arrhythmia, sudden death or non-specific
symptoms such as dyspnoea and syncope. At present, there are no guidelines or dedicated
studies assessing the treatment of an aberrant coronary artery leaving management
options for these patients controversial.
Methods
Selected international cardiothoracic surgeons were surveyed electronically in November
2016 to determine whether consensus exists on different management aspects for patients
with an aberrant coronary artery arising from the contralateral sinus with an interarterial
course.
Results
For asymptomatic patients with either an aberrant left main coronary artery (ALMCA)
arising from the contralateral sinus or an aberrant right main coronary artery (ARMCA)
arising from the contralateral sinus, there was no consensus on surgical correction
of the anomaly. If myocardial ischaemia was demonstrated on either coronary angiography
with fractional flow reserve measurements and/or stress myocardial perfusion scan,
surgical correction was the consensus between the surveyed surgeons. If surgery was
deemed appropriate, coronary artery bypass surgery utilising the internal mammary
artery was marginally preferred by the respondents in patients with an ALMCA whilst
unroofing of the coronary ostium was preferred in patients with an ARMCA. Although
no consensus was reached, a large proportion of respondents would not treat a patient
over the age of 30 years differently compared to those under 30 years old.
Conclusions
For symptomatic patients or if myocardial ischaemia is demonstrated on either coronary
angiography with fractional flow reserve measurements and/or stress myocardial perfusion
scan, surgical correction is indicated.
Keywords
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Article info
Publication history
Published online: July 03, 2017
Accepted:
June 2,
2017
Received:
March 28,
2017
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
