An unroofing procedure is performed when a coronary artery arises from the wrong part of the aorta and has to travel between the aorta and the lung artery to provide blood flow to the heart muscle (so-called anomalous course). Instead of the blood vessel taking a straight shot into the heart muscle, it has to curve acutely and travel partly in the wall of the aorta. In some cases of exercise, the blood flow through the coronary artery may be impaired and if that happens, then the heart muscle won't receive its proper amount of blood flow. This can result in damage to the heart muscle, dangerous rhythm problems and even sudden death. When a surgeon does an unroofing procedure, they open the aortic wall along the back of the anomalous coronary artery, so that plenty of blood flow can get into the coronary artery. The long term outcomes from this procedure are still not known, but since there is a small incidence of sudden death with anomalous origin of the left coronary artery from the right cusp, it is performed preventatively.
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