Introduction
Anomalous aortic origin of coronary arteries (AAOCA) is a non-infrequent congenital, anatomic heart anomaly whose prevalence in the population is dramatically heightened in the last years [1-4].
The association with sudden cardiac death in athletes has improved the medical awareness of this malformation leading to an increase in cardiologic investigations, especially before competitive sport practice [5].
Several studies have attempted to quantify this value, with estimates ranging between 0.1 and 1% in both the adult and pediatric population. Anomalous aortic origin of right coronary artery (AAORCA) is from three to six times more frequent than anomalous aortic origin of left coronary artery (AAOLCA), that is, on the other hand more commonly associated with sudden cardiac death [6,7].
Surgical management of AAOCA continues to be a matter of debate especially in asymptomatic AAORCA [8-10]. Several surgical techniques have been developed in the last years with excellent results in terms of mortality and freedom from re-operations. Although the unroofing is the most used technique, neo-ostioplasty and coronary reimplantation are effective and have showed comparable outcomes [11-13]. Regardless of the technique used, is it the overall shape and the normalization of the take-off angle the mainstay of surgical management [13]. Also, unfortunately, there were some reports that have showed symptoms recurrence after surgery [14,15].
The aim of the present study is to describe our surgical management in AAOCA describing how an anatomic-based patient-specific approach is associated with complete symptoms resolution at mid-term follow-up.