2019 年 25 巻 3 号 p. 72-77
Anomalous aortic origin of a coronary artery is a congenital anomaly that carries a risk of a life-threatening cardiovascular event, such as sudden cardiac death or myocardial infarction. Some therapeutic guidelines have been proposed, but specific indications and treatment procedures remain controversial. In general, all patients with anomalous aortic origin of the left coronary artery are indicated for surgical repair, whereas surgical indications for anomalous aortic origin of the right coronary artery have not been established. Various surgical therapies (e.g., coronary artery bypass graft, unroofing, reimplantation, and pulmonary artery translocation) have been reported. The unroofing procedure is presumably a reasonable and safe approach for revascularization in patients with anomalous aortic origin of a coronary artery with a long intramural course, despite the risk of aortic insufficiency or recurrent sudden cardiac arrest. Among surgical procedures, reimplantation is conceivably the most physiologically appropriate and durable procedure. However, the procedure is technically demanding procedure because of the requirement for extensive dissection and vessel mobilization. Currently, optical surgical intervention is proposed based on coronary anatomy. With increasing numbers of treated patients and improved diagnostic tools, based on both anatomy and function, this anomaly may be definitely resolved in the near future.