Surgical treatment of right coronary arteries with anomalous origin and slit ostium

Background. Right coronary arteries arising in the left sinus or ectopically in the anterior coronary sinus with slit ostium course inside the aorta. They are subject to variable systolic compression and can cause myocardial ischemia with its sequelae or death. Methods. From May 1991 to March 2003, we treated 16 patients with anomalous origin of the right coronary artery from the left sinus and 4 whose right coronary artery arose ectopically in the anterior sinus. All patients had a slit ostium and underwent transaortic unroofing of the trunk to modify the proximal portion of the anomalous artery. Results. All patients survived operation, although 1 patient died of unrelated causes. Nineteen patients were followed for a period from 0.2 to 11.8 years (median age, 53 years). One experienced angina 1 year after surgery and underwent percutaneous transluminal coronary angioplasty of a left internal thoracic to left anterior descending coronary artery anastomosis. All patients are New York Heart Association class 1, without angina; none has sustained a myocardial infarction or required reoperation. Conclusions. Right coronary arteries that arise in anomalous fashion with a slit ostium can cause myocardial ischemia or death. Transaortic modification of the anomalous trunk addresses the anatomic and pathophysiologic features of the malformation that cause myocardial ischemia. Excellent results can be achieved with this surgical approach. (C) 2004 by The Society of Thoracic Surgeons.