Complex Reimplantation of Aneurysmal Left Main Coronary Artery During Reoperative Aortic Root Replacement.

Coronary artery fistula (CAF), an aberrant connection between a coronary artery and a chamber of the heart or great vessel, is a rare congenital abnormality for which management has been previously described. However, there remains a paucity of literature on the treatment of sequelae, such as coronary artery aneurysm, in adults with acquired cardiac disease. We present an innovative surgical approach for the repair of an aneurysmal aortic root in a patient with a history of a coronary artery fistula repair and aortic valve replacement. The described operation integrates techniques of advanced aortic surgery with an interposition graft for the reimplantation of a massively dilated left main coronary artery. As life expectancy improves for patients with congenital cardiac abnormalities, the management of acquired cardiac disease must continue to evolve to appropriately treat this population.