Hitesh Agrawal, MD, S. Kristen Sexson-Tejtel, MD, PhD, Athar M

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Aborted Sudden Cardiac Death After Unroofing of Anomalous Left Coronary Artery Hitesh Agrawal, MD, S. Kristen Sexson-Tejtel, MD, PhD, Athar M. Qureshi, MD, Mahboob Alam, MD, Prakash Masand, MD, Charles D. Fraser, MD, Silvana Molossi, MD, PhD, Carlos M. Mery, MD, MPH The Annals of Thoracic Surgery Volume 104, Issue 3, Pages e265-e267 (September 2017) DOI: 10.1016/j.athoracsur.2017.03.016 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Intraoperative findings. (A) At initial operation, the left coronary artery ostium (arrow) was slitlike and arising from the right sinus with a short intramural course. (B) After unroofing, the ostium is round with no stenosis. (C) On reoperation, the left coronary artery had a wide open ostium, but continued to travel behind the intercoronary pillar (arrowhead). (D) A long left anterior descending myocardial bridge was unroofed. The Annals of Thoracic Surgery 2017 104, e265-e267DOI: (10.1016/j.athoracsur.2017.03.016) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Computed tomographic angiography (CTA) shows a wide-open left coronary ostium (arrow) arising from the right sinus with apparent compression of the proximal coronary between the intercoronary pillar and the pulmonary artery (arrowheads). (B) A 1.9-cm intramyocardial segment of the left anterior descending artery was also found. (C) CTA after the second operation shows a wide-open left coronary artery (arrow) arising normally from the left sinus. (D) Virtual angioscopy obtained using three-dimensional post-processing shows a normal, round ostium (arrow) arising to the left of the intercoronary commissure (arrowhead). The Annals of Thoracic Surgery 2017 104, e265-e267DOI: (10.1016/j.athoracsur.2017.03.016) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Intravascular ultrasound (IVUS) imaging before coronary translocation show significant compression of the left coronary artery. (B) There was no compression noted after translocation. Both images represent the minimal luminal diameter of the left main coronary artery ostium as obtained by pullbacks with the IVUS catheter. The Annals of Thoracic Surgery 2017 104, e265-e267DOI: (10.1016/j.athoracsur.2017.03.016) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions