Aberrant coronary artery origin from the aorta. Report of 18 patients, review of literature and delineation of natural history and management.

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Abstract
The pathogenesis and management of aberrant origin of a coronary artery from the aorta were studied in 18 patients whose right (RCA) or left (LCA) coronary artery arose aberrantly and passed between the aorta and right ventricular infundibulum. Of 9 patients with aberrant LCA, 3 young males died suddenly after exertion, each with proximal focal LCA stenosis. None of 6 adults with angina (ages 36-70 yr) studied angiographically had proximal LCA stenosis. Unlike the young, sudden death-prone patients in whom coronary bypass of proximal stenosis may have prophylactic value, older patients with aberrant LCA did not have proximal stenosis or sudden death and LCA bypass for sudden death prophylaxis is not warranted. Of 9 patients (ages 18-60 yr) with aberrant origin and course of the RCA, 7 patients studied angiographically because of angina had no focal proximal RCA stenosis, but 2 had hypoplastic RCA ostia. Although a potential concern in the latter patients, sudden death was not reported with aberrant RCA. In the absence of syncope, RCA bypass for sudden death prophylaxis is not indicated.