ArticleJACC. Case reports2026
Successful Replication of the Transconal Repair Technique for Anomalous Aortic Origin of the Left Main Coronary Artery.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAnomalous aortic origin of the left main coronary artery (AAOLCA) with a transseptal course is an exceptionally rare anomaly associated with myocardial ischemia and sudden cardiac death. Surgical management has traditionally required complex repair. CASE SUMMARY: A 41-year-old man presented with acute chest pain and ST-segment elevations. Angiography revealed no obstructive coronary disease but identified an AAOLCA from the right coronary sinus with a transseptal course. Physiologic testing demonstrated ischemia under dobutamine stress. The patient underwent successful transconal unroofing and right ventricular outflow tract reconstruction through replication of a novel transconal approach. DISCUSSION: This case highlights the importance of multimodality imaging and physiologic assessment in diagnosing high-risk AAOLCA variants. Careful unroofing and patch reconstruction can relieve compression while avoiding conduction injury or obstruction of the right ventricular outflow tract. TAKE-HOME MESSAGE: Transconal unroofing for AAOLCA with extended transseptal course is safe, reproducible, and provides favorable early outcomes.
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