The chair assembled a multidisciplinary group of experts, the coauthors of this article, who include congenital cardiac surgeons and adult and pediatric cardiologists.
Tweddell, MD, as chair of the AAOCA Working Group and asked him to appoint an AAOCA Guidelines writing committee to create evidence-based guidelines for the AATS Guidelines Committee. The Guidelines Committee selected James S. The AATS Guidelines Committee identified the management of AAOCA as a key topic in cardiothoracic surgery suitable for the establishment of clinical guidelines.
This review and recommendations are directed at AAOCA from the opposite sinus of Valsalva with an interarterial course ( Figure 1). However, the course becomes important if either the aberrant left main coronary artery or right coronary artery travels between the 2 great vessels. These previous subtypes are generally not believed to be clinically significant. The AAOLCA or left anterior descending coronary artery alone can course through the conal septum (intraseptal or intraconal or intramyocardial). The anomalous aortic origin of the left main coronary artery (AAOLCA) or right coronary artery (AAORCA) can course in front of the pulmonary artery (pre-pulmonic) or posterior to the aorta (posterior/retroaortic). The course the anomalous coronary artery takes appears to have an impact on its risk of SCD. For this article, we refer to this as anomalous aortic origin of a coronary artery (AAOCA) from the inappropriate coronary sinus. The aberrant vessel may arise above the inappropriate sinus or above the commissure and not truly from the sinus itself.
However, observational studies have identified the coronary anomalies that appear to be most prevalent and in which the SCD risk appears to be the greatest: when both coronary arteries arise from the same aortic sinus with either a single ostium or 2 separate ostia ( Table 1). In many types of coronary anomalies, the risk of sudden cardiac death (SCD) is largely unknown, as the anomalies are quite rare. The objective of this project was to establish consensus 2016 American Association for Thoracic Surgery (AATS) evidence-based guidelines for the management of anomalous aortic origin of a coronary artery.
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