Coronary Artery Anomalies in Common Arterial Trunk: Proposal of a New Anatomical Classification

TL;DR

This paper proposes a new classification system for coronary artery anomalies in common arterial trunk to improve surgical decision-making and patient outcomes.

Contribution

The novel contribution is a proposed anatomical classification of six coronary artery abnormalities specific to common arterial trunk.

Findings

Coronary artery anomalies occur in 5%-20% of common arterial trunk cases.

Heterogeneous categorization limits understanding of prognostic impact.

A uniform classification may improve clinical decision-making in high-risk cases.

Abstract

Coronary artery abnormalities (CAAs) are frequently encountered in common arterial trunk (CAT), with an estimated incidence of 5%-20%. However, their prognostic implications remain unclear. Surgical challenges potentially arise due to coronary arteries crossing the right ventricular outflow tract (RVOT), close proximity of the coronary and pulmonary orifices, and distortion to the proximal coronary segments and ostia during arch reconstruction or truncal valve replacement. Some studies have demonstrated that CAAs confer worse outcomes after CAT repair, while others have reported no significant prognostic impact. Both the number and subtype of CAAs may influence outcomes, but heterogeneous categorization limits the conclusions that can be drawn from existing studies. A uniform classification of CAAs in CAT is warranted to better ascertain the prognostic impact of CAA burden and morphology. This may enable more focused decision-making in clinical scenarios where a high-risk CAA pattern is suspected. For example, it may help inform the intraoperative trade-off between probing the coronaries to define their precise morphology against the risk of causing damage. We propose a classification consisting of 6 abnormalities: (1) single coronary artery, (2) ostial stenosis, (3) intramural course, (4) juxtacommissural origin, (5) coronary crossing RVOT, and (6) close proximity of coronary and pulmonary orifices.

Coronary artery abnormalities (CAAs), congenital lesions characterized by abnormal origin or course of the epicardial coronary arteries, are associated with common arterial trunk (CAT), also known as truncus arteriosus.

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