Management and Anesthetic Considerations for Patients With Anomalous Aortic Origin of a Coronary Artery

Abstract

The term "coronary artery anomalies" encompasses a large and heterogeneous group of disorders that may affect origin, intrinsic anatomy, course, location, and termination of the coronary arteries. With these different anatomies, presentation, symptoms, and outcomes are heterogeneous as well. While significant efforts are directed toward improving diagnosis and risk-stratification, best evidence-guided practices remain in evolution. Data about anesthetic management of patients with coronary anomalies are lacking as well. This review aims to provide the anesthesiologist with a better understanding of an important subgroup of coronary artery anomalies: anomalous aortic origin of a coronary artery. We will discuss classification, pathophysiology, incidence, evaluation, management, and anesthetic implications of this potentially fatal disease group.

Keywords: anomalous aortic origin of a coronary artery; anomalous coronary artery arising from the opposite sinus of Valsalva; coronary artery anomalies; interarterial course; intramural course; sudden cardiac death.