{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T23:14:46Z","timestamp":1789082086475,"version":"build-2803163510"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T00:00:00Z","timestamp":1604880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Anomalous aortic origin of the coronary artery (AAOCA) with an interarterial \u00b1 an intramural course is a rare anomaly that carries a high risk of ischaemic events and even sudden death. The unroofing of the intramural course has been adopted as the gold standard surgical treatment. However, some anatomical forms need alternative techniques.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>We reviewed the surgical cohort with AAOCA managed at our institution between 2005 and 2019 and analysed the anatomical and clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Thirty-nine patients underwent surgical interventions. The median age was 14\u2009years (10\u201326\u2009years). Twenty-eight patients (72%) had right AAOCA, and 11 (28%) had left AAOCA. Thirty-one (80%) patients presented with symptoms. The symptoms were chest pain in 22 patients (56%), syncope in 5 patients (13%), cardiac arrest during exercise in 2 patients (5%), dyspnoea in 6 patients (15%) and dizziness in 13 patients (33%). An ischaemic test was performed in 32 patients: Only 4 patients (10%) had positive results from the ischaemic test. All patients had computed tomography angiography scans to confirm the precise anatomical features of the anomaly. Repair techniques included 30 unroofing procedures (77%) with an associated translocation of the pulmonary artery for 11 patients in our early experience. In 6 patients the unroofing procedure was not feasible because of the absence of an intramural distinct segment or was judged intraoperatively not appropriate. A reimplantation of the anomalous coronary artery was performed in 2 patients (5%); 3 patients had coronary artery bypass grafting procedures (7%); and 3 (8%) had an isolated translocation of the pulmonary artery. There were no early or late deaths. All patients were free of symptoms. Computed tomography angiography scans performed in 31 cases showed a patent, non-restrictive coronary artery ostium. Seventeen patients underwent postoperative ischaemia testing and showed no evidence of ischaemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Surgical correction in AAOCA is mandatory both for symptomatic and for asymptomatic patients with evidence of myocardial ischaemia under stress or with a restricted coronary artery segment. Surgical unroofing remains the gold standard but is not appropriate for all forms: alternative techniques should be considered. Surgical results are promising.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa379","type":"journal-article","created":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T19:23:34Z","timestamp":1601407414000},"page":"705-710","source":"Crossref","is-referenced-by-count":14,"title":["Anomalous aortic origin of coronary arteries: is the unroofing procedure always appropriate?"],"prefix":"10.1093","volume":"59","author":[{"given":"Meriem","family":"Mostefa Kara","sequence":"first","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Fournier","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8695-0503","authenticated-orcid":false,"given":"Sebastien","family":"Hascoet","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Van Aerschot","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regine","family":"Roussin","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy","family":"El Zoghbi","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Belli","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adult Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph Reference Center of Complex Congenital Heart Diseases M3C, Le Plessis Robinson, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,9]]},"reference":[{"key":"2021050518300730500_ezaa379-B1","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1177\/2150135116641892","article-title":"Surgical repair of 115 patients with anomalous aortic origin of a coronary artery from a single institution","volume":"7","author":"Mainwaring","year":"2016","journal-title":"World J Pediatr Congenit Heart Surg"},{"key":"2021050518300730500_ezaa379-B2","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1161\/CIRCIMAGING.113.000278","article-title":"Novel imaging of coronary artery anomalies to assess their prevalence, the causes of clinical symptoms, and the risk of sudden cardiac death","volume":"7","author":"Angelini","year":"2014","journal-title":"Circ Cardiovasc Imaging"},{"key":"2021050518300730500_ezaa379-B3","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1016\/S0735-1097(00)00566-0","article-title":"Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes","volume":"35","author":"Basso","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2021050518300730500_ezaa379-B4","doi-asserted-by":"crossref","first-page":"604","DOI":"10.21037\/acs.2018.08.02","article-title":"Surgical management of anomalous coronary arteries","volume":"7","author":"Ong","year":"2018","journal-title":"Ann Cardiothorac Surg"},{"key":"2021050518300730500_ezaa379-B5","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.jtcvs.2016.07.058","article-title":"Anomalous aortic origin of a coronary artery: the gaps and the guidelines","volume":"153","author":"Jacobs","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021050518300730500_ezaa379-B6","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.athoracsur.2011.03.127","article-title":"Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients","volume":"92","author":"Mainwaring","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2021050518300730500_ezaa379-B7","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1007\/s00330-014-3454-9","article-title":"Anatomical criteria of malignancy by computed tomography angiography in patients with anomalous coronary arteries with an interarterial course","volume":"25","author":"Ashrafpoor","year":"2015","journal-title":"Eur Radiol"},{"key":"2021050518300730500_ezaa379-B8","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1053\/j.semtcvs.2014.08.001","article-title":"Anomalous aortic origin of a coronary artery: toward a standardized approach","volume":"26","author":"Mery","year":"2014","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2021050518300730500_ezaa379-B9","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.jtcvs.2016.06.066","article-title":"Expert consensus guidelines: anomalous aortic origin of a coronary artery","volume":"153","author":"Brothers","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021050518300730500_ezaa379-B10","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1161\/01.CIR.0000016175.49835.57","article-title":"Coronary anomalies: incidence, pathophysiology, and clinical relevance","volume":"105","author":"Angelini","year":"2002","journal-title":"Circulation"},{"key":"2021050518300730500_ezaa379-B11","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.ijcard.2019.02.007","article-title":"Anomalous aortic origin of coronary arteries: early results on clinical management from an international multicenter study","volume":"291","author":"Padalino","year":"2019","journal-title":"Int J Cardiol"},{"key":"2021050518300730500_ezaa379-B12","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.jtcvs.2017.08.116","article-title":"Outcomes of surgical intervention for anomalous aortic origin of a coronary artery: a large contemporary prospective cohort study","volume":"155","author":"Mery","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021050518300730500_ezaa379-B13","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.athoracsur.2010.11.002","article-title":"Surgery for anomalous aortic origin of the coronary artery","volume":"91","author":"Mumtaz","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2021050518300730500_ezaa379-B14","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1016\/j.jtcvs.2017.11.003","article-title":"Surgical unroofing of intramural anomalous aortic origin of a coronary artery in pediatric patients: single-center perspective","volume":"155","author":"Sachdeva","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021050518300730500_ezaa379-B15","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/j.jtcvs.2011.02.004","article-title":"Ten-year experience with surgical unroofing of anomalous aortic origin of a coronary artery from the opposite sinus with an interarterial course","volume":"142","author":"Frommelt","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021050518300730500_ezaa379-B16","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.jtcvs.2015.05.060","article-title":"Surgery for anomalous aortic origin of a coronary artery: more is better?","volume":"150","author":"Bradley","year":"2015","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/3\/705\/37830349\/ezaa379.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/3\/705\/37830349\/ezaa379.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T14:59:48Z","timestamp":1620313188000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/59\/3\/705\/5964167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,9]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,11,9]]},"published-print":{"date-parts":[[2021,4,13]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaa379","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3,1]]},"published":{"date-parts":[[2020,11,9]]}}}