Anomalous Connection of the Right Coronary Artery to the Opposite Sinus with Interarterial Course: Direct Reimplantation without Transverse Aortotomy

Introduction: Anomalous connection of the right coronary artery to the opposite coronary sinus associates an inter-arterial course, an intramural course and Ostia anomalies. They are recognized to be a cause of sudden death in athletes. There is no recommendation concerning the therapeutic attitude. The surgical treatment in particular in adulthood is very controversial.
Material and method: This is a retrospective study of 30 cases operated on in our center between January 2003 and December 2016.
Results: 16 patients had less than 18 and 10 more than 30 years old. 14 patients practiced sport. 86, 6 % were symptomatic with 5 sudden deaths. The average time between the diagnosis and the intervention was of 18, 5 months (0, 5-179). All the patients benefited of a coroscanner and of a reimplantation in anatomical position. The average time of follow-up was of 25, 6 months (1-701) with a death at 3 post-operative months. At the date of breaking news 92, 8% were NYHA I and 60 % had taken back a physical activity.
Conclusion: Only the reimplantation allows restoring the coronary anatomy and authorizing patients to practice sports safely. The evolution or the long-term appearance of a coronaropathy on this right reimplanted coronary artery must be estimated.