Repair of Intramural Coronary Artery in Anomalous Aortic Origin of a Coronary Artery

It has become increasingly evident that anomalous aortic origin of a coronary artery is considered as an important anatomic anomaly in adolescents and adults. The question is whether or not surgical repair should be performed in asymptomatic patients. Previous reports showed that the numbers of asymptomatic patients who result in a sudden cardiac death are not negligible. Another reason to proceed to surgical intervention is the improvement in understanding this unique anatomy and the refinement of surgical techniques that brought the satisfied outcomes. Physiologic repair, that is, coronary artery bypass grafting was used to be the first choice of surgery; however, anatomic repair, such as coronary implantation and repair of intramural coronary artery is considered favorable in adolescents as “radical” oppose to “palliative” repair. We report our technique to relieve the intramural coronary artery based on the experience in arterial switch operation performed in neonates.