The “Hinge-Twist” Technique for Anomalous Origin of the Left Coronary Artery

A murmur was heard in an asymptomatic boy (age 4), and transthoracic echocardiography revealed anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (age 6). Confirmed by catheterization and computed tomographic angiography (age 10), the LMCA followed a short interarterial course between the aorta and main pulmonary artery before supplying the anterior descending and circumflex coronary arteries. An intramural segment was not clearly seen. Results of stress testing were normal. Because sudden death was a concern, the patient underwent surgery at age 11. The “hinge-twist” technique was utilized in the absence of an intramural component or ostial stenosis in an effort to avoid the long-term complications of coronary reimplantation, ostial patching, or bypass grafting.