Maller Vijetha,  Boston Umar,  Knott-craig Christopher

Final Pr. ID: Poster #: CR-003

Transseptal course is defined as the anomalous course of left coronary artery (LCA) after its anomalous origin from the opposite sinus, when the coronary artery takes a sharp turn to dip into the basal interventricular septum behind the right ventricular outflow tract (RVOT) and emerge laterally to the epicardial surface. Transseptal course is generally considered by some as benign entity. However, case reports of severe cardiac symptoms such as myocardial ischemia, arrhythmia, and even sudden cardiac death have been sporadically reported. Surgical management in symptomatic patients can be challenging. One of the latest surgical approach to this anomaly is transection of the RVOT, unroofing the septal course of the LCA, followed repair of the posterior wall of the RVOT by placement of rectangular strip of autologous pericardium.
We present a 17-year-old male who was noted to have an anomalous left coronary artery on screening echocardiography. CT coronary angiography revealed anomalous origin of left anterior descending artery (LAD) from the right sinus of Valsalva with a long intraconal/transseptal course that measured 43mm in length. The left circumflex artery (LCx) also had anomalous origin from the right sinus of Valsalva with retroaortic course and a fistula with pulmonary artery. This patient had 5 ostia at the right sinus of Valsalva with separate origins of two conus arteries. This patient had successful transconal unroofing of the anomalous LAD and ligation of the LCX to pulmonary artery fistula.
We will discuss the preoperative as well as postoperative CT coronary angiography using multiplanar views, 3D hollow reconstructions, as well as virtual endoluminal views. The CT coronary angiography characteristics of transeptal course of anomalous coronary artery will be discussed in detail. Illustrations with 3D reconstructions which helped our cardiothoracic surgeons to plan the transconal unroofing of the anomalous LAD will be discussed. Recognition of transeptal course of the coronary artery and describing its course and relation to the RVOT including the assessment of the overlying conal septal myocardial thickness with the help of multiplanar views and 3D views can help better surgical planning. Read More

Authors:  Maller Vijetha , Boston Umar , Knott-craig Christopher

Keywords:  Transseptal course, coronary fistula, transconal unroofing