Personalized surgical treatment options for anomalous origin of right coronary artery: Two case reports

The majority of infants born with an anomalous origin of the left coronary artery from the pulmonary artery die within the first year of life. This malformation produces a clinical picture of episodes of sweating, cyanosis and pallor usually following feeding. Associated findings are gross cardiac enlargement and electrocardiographic evidence of myocardial ischemia. Perfusion studies at necropsy indicate that extensive anastomoses allow free passage of blood from the normal right coronary artery to the left. There now appears evidence that flow through the anomalous left coronary artery is into the pulmonary artery rather than away from it. Thus although there is oxygenated blood in the left coronary artery, it does not reach the myocardium but passes instead to the low-resistance circuit of the pulmonary artery. Ligation of the aberrant vessel at its origin would prevent retrograde flow and allow perfusion of the left ventricle by blood supplied through the anastomoses from the right coronary artery. This would in effect convert the anomaly into that of a single coronary artery arising from the aorta, which situation is usually compatible with a normal life expectancy. Preliminary experience with this suggested surgical treatment appears encouraging in one of the cases reported.

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Anomalous Origin of the Circumflex Coronary Artery From the Right Pulmonary Artery Associated With Anomalous Aortic Origin of the Right Coronary Artery: A Case Report of Surgical Treatment

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120903958 ◽

2020 ◽

Vol 11 (4) ◽

pp. 501-503

Author(s):

Roman Sekelyk ◽

Dmytro Kozhokar ◽

Andrii Kurkevych ◽

Oleksandra Motrechko ◽

Illya Yemets

Keyword(s):

Case Report ◽

Coronary Artery ◽

Surgical Treatment ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Anomalous Origin ◽

Circumflex Coronary Artery ◽

Aortic Sinus ◽

Right Pulmonary Artery ◽

The Right

We present a patient with the extremely rare coexistence of two distinct coronary artery malformations: anomalous aortic origin of the right coronary artery from the left aortic sinus with intramural course and anomalous origin of the circumflex coronary artery from the right pulmonary artery. Surgical reimplantation of the anomalous left circumflex coronary artery to the aorta and unroofing of the intramural portion of the anomalous right coronary artery were performed.

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Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2016.002 ◽

2015 ◽

Vol 4 (1) ◽

pp. 131-134

Author(s):

Ali Refatllari ◽

Ermal Likaj ◽

Selman Dumani ◽

Endri Hasimi ◽

Artan Goda

Keyword(s):

Coronary Artery ◽

Surgical Treatment ◽

Right Coronary Artery ◽

Mitral Stenosis ◽

Saphenous Vein Graft ◽

Anomalous Origin ◽

Lv Function ◽

Sinus Of Valsalva ◽

The Right ◽

Left Sinus Of Valsalva

BACKGROUND: An anomalous origin of the right coronary artery is rarely observed, with a reported incidence between 0.026% and 0.25%. This condition is often completely asymptomatic and is found incidentally during angiographic evaluation for other cardiac diseases. However some patients present with exertion angina or sudden death. Surgical treatment in patients with anomalous RCA is still controversial. Treatment can be conservative, angioplasty or surgery.CASE PRESENTATION: A 59-year-old man was admitted with severe mitral stenosis. He complained exertion and rest dyspnea, NYHA III class. He had sequels of embolic stroke, results of left atrial thrombus. Echocardiography showed calcified severe mitral stenosis with mitral orifice area of 1.1 square centimeters with PSPAP 60 mmHg and normal LV function. Routine coronary angiography before surgery showed aberrant origin of RCA from the left sinus of Valsalva with 90% stenosis at his origin. Multi-slice computed tomography proved the diagnosis of anomalous RCA arising from the left sinus of Valsalva and taking an inter-arterial course between the aorta and pulmonary artery. The patient underwent mitral valve replacement with mechanical St. Jude prosthesis No 29 and saphenous vein graft to RCA. We chose by-pass grafting techniques because after aortotomy, RCA was too close to LMCA, intramural course was too short and stenosis of RCA was outside of aortic wall. The patient's perioperative course was without complications and patient was discharged on the seventh postoperative day.CONCLUSION: Correction of anomalous of the origin of right coronary artery is mandatory in cases where patient has to be operated for other cardiac causes.

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