Direct Reimplantation Procedure in Anomalous Aortic Origin of the Right Coronary Artery: Long-Term Single Center Outcomes

2021 ◽  
Vol 12 (6) ◽  
pp. 693-699
Author(s):  
Daouda Amadou ◽  
Julia Mitchell ◽  
Christian Bulescu ◽  
Olivier Metton ◽  
Roland Henaine ◽  
...  
Keyword(s):  
Physical Activity ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Early Death ◽  
Time Lapse ◽  
Single Center ◽  
Complete Restoration ◽  
Single Center Study ◽  
The Right

Background: Anomalous aortic origin of the right coronary artery is known to be a cause of sudden cardiac death in athletes. There are no specific guidelines concerning treatment strategy in the literature. The aim of this study is to describe and report our experience of direct reimplantation technique in the treatment of this anomaly. Methods: This was a retrospective single center study of 30 patients who underwent surgery in the congenital heart disease unit of Louis Pradel Heart and Lung Hospital between January 2003 and December 2016. The mean follow-up was seven years (3 months-17 years). Results: Thirty patients underwent surgery. The median age was 17 years (0.2-52 years). There were 24 males. The median weight was 58 kg (3.6-118 kg). Fourteen patients were actively engaged in sports. Twenty-six patients had exertional chest pain or syncope. The median time lapse between diagnosis and intervention was 4.5 months (0.5-179 months). Twenty-seven (90%) patients underwent reimplantation of the anomalous coronary artery without transverse aortotomy, while in 3 (10%) patients transverse aortotomy was used to facilitate reimplantation to avoid tension at the anastomosis. There was no early death; one late death occurred in the third postoperative month. At the last follow-up, all patients had returned to normal physical activity without evidence of ischemia. Conclusions: Direct reimplantation allows for a complete restoration of the coronary anatomy and enables patients to return to normal physical activity. Our study shows encouraging results using a direct reimplantation technique without aortotomy.

scholarly journals Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francisco Albuquerque ◽  
Pedro de Araújo Gonçalves ◽  
Hugo Marques ◽  
António Ferreira ◽  
Pedro Freitas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Right Coronary Artery ◽  
Cardiac Death ◽  
Anomalous Origin ◽  
Cardiac Symptoms ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
The Right

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

Coronary Revascularization in Children at a Mexican Cardiac Center: Thirteen-Year Outcomes

2017 ◽  
Vol 8 (5) ◽  
pp. 600-604 ◽  
Author(s):  
Samuel E. Ramírez-Marroquín ◽  
Alejandra Iturriaga-Hernández ◽  
Juan Calderón-Colmenero ◽  
Antonio Benita-Bordes ◽  
Jorge L. Cervantes-Salazar
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Right Coronary Artery ◽  
Internal Thoracic Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Diagnostic Study ◽  
Bilateral Internal Thoracic Artery ◽  
The Right

Background: The indications for pediatric coronary revascularization are diverse. There are a large proportion of patients with sequelae of severe inflammatory diseases such as Kawasaki disease, and other less common causes. Methods: Retrospective review of ten pediatric patients undergoing coronary artery bypass surgery from January 2004 to December 2016. Results: Ten children and adolescents ranging in age from 2 to 17 (median, 6) years at operation were followed up for as long as 13 years with a median follow-up of 2 years. The surgical indications include ischemia symptoms and/or coronary stenosis angiographically documented. Diagnoses include Kawasaki disease, anomalous origin of the left coronary artery from the pulmonary artery, and iatrogenic lesion of the right coronary artery. All the surgical procedures were performed with cardiopulmonary bypass with crystalloid cardioplegic arrest. The number of distal anastomoses was 1.6 per patient, and the left internal thoracic artery was used in one patient, the right internal thoracic artery in four patients, bilateral internal thoracic artery in four patients, and bilateral internal thoracic artery plus left radial artery in one patient, most frequently for right coronary artery revascularization. The patients underwent noninvasive diagnostic study during follow-up to evaluate their coronary status. The ten patients had no symptoms, and there was no mortality. Conclusions: Although survival was excellent after pediatric coronary bypass in our center, we need to continue the follow-up. Coronary revascularization by means of arterial grafting is a safe and reliable surgical modality for coronary disease in children.

Anomalous Origin of Right Coronary Artery From Left Coronary Sinus—13 Cases Treated With the Reimplantation Technique

2017 ◽  
Vol 8 (3) ◽  
pp. 315-320 ◽  
Author(s):  
Alain Cubero ◽  
Alejandro Crespo ◽  
Gadah Hamzeh ◽  
Andrés Cortes ◽  
Daniel Rivas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Anomalous Origin ◽  
Atypical Chest Pain ◽  
Asymptomatic Patients ◽  
Clinically Significant ◽  
Artery Disease ◽  
The Right

Objectives: Anomalous aortic origin of a coronary artery is uncommon but potentially clinically significant. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe our experience with surgical reimplantation and results at midterm follow-up. Methods: Between February 2003 and July 2016, a total of 13 patients with anomalous origin of the right coronary artery (RCA) from the left sinus underwent surgical reimplantation. Results: Mean age was 39 years (range, 11-72 years). Eight patients presented with dyspnea and angina, two with acute myocardial infarction, and the remaining three were studied for atypical chest pain and ventricular premature contractions. Definitive diagnosis was achieved with coronary angiography in eight cases and with computed tomography scan in five. In all cases, the anomalous origin of the RCA from the left sinus had an intramural course except one case with interarterial (but not intramural) course. At operation, the RCA was dissected at the takeoff from the intramural course and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated atherosclerotic coronary artery disease that required stent placement postoperatively. After a mean follow-up of 65 months (maximum 12 years), all patients are asymptomatic and have returned to exercise without limitations. Conclusions: The reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives similar results to the unroofing technique.

scholarly journals Coronary intervention in anomalous origin of the right coronary artery (ARCA) from the left sinus of valsalva (LSOV): A single center experience

2014 ◽  
Vol 66 (4) ◽  
pp. 430-434 ◽  
Author(s):  
Kalaichelvan Uthayakumaran ◽  
Vijayakumar Subban ◽  
Anitha Lakshmanan ◽  
Balaji Pakshirajan ◽  
Ramkumar Solirajaram ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Intervention ◽  
Anomalous Origin ◽  
Sinus Of Valsalva ◽  
Single Center ◽  
Single Center Experience ◽  
The Right ◽  
Left Sinus Of Valsalva

Short-term Assessment of Radial Artery Grafts With Multidetector Computed Tomography

2020 ◽  
Author(s):  
En Qiao ◽  
Yuetang Wang ◽  
Jun Yu ◽  
Xu Wang ◽  
Xinjin Luo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Radial Artery ◽  
Right Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Graft Patency ◽  
Short Term ◽  
The Right

Abstract Background The clinical use of radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines, and the application of multidetector computed tomography (MDCT) in the evaluation of graft patency is still to be verified. This study aims to report the short-term results of RA in CABG with MDCT. Methods The study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2007 to 2008, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis. Results MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. A total of 150 distal anastomoses were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). Functional graft patency of the left internal mammary artery (LIMA) was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of saphenous vein graft (SVG) of 81.1% (30/37). And the RA targeting the left coronary artery system might have better patency than that of the RA targeting the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686). Conclusions MDCT could provide excellent visualization of grafts in CABG. The short-term patency rate of RA grafts is good, and the RA might be associated with better patency when targeted to the left but not the right coronary artery.

scholarly journals Quantitative Evaluation of Coronary Plaque Progression by Computed Tomographic Angiography

2017 ◽  
Vol 44 (5) ◽  
pp. 312-319
Author(s):  
Xiujian Liu ◽  
Guanghui Wu ◽  
Chuangye Xu ◽  
Yuna He ◽  
Lixia Shu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Plaque Volume ◽  
Computed Tomographic ◽  
Luminal Area ◽  
The Right ◽  
Tomographic Angiography

Understanding plaque formation in patients at risk for coronary artery disease—the leading cause of morbidity and death in the world—enables physicians to better determine whether and how to treat these individuals. We used computed tomographic angiography to quantitatively evaluate the progression of nonculprit coronary plaques along the full length of the right coronary artery in 21 patients with acute coronary syndrome. Each right coronary artery was analyzed in sequential, 3-mm-long segments, and the minimum luminal area, plaque burden, and plaque volume within each segment were evaluated at baseline and at 12-month follow-up. Serial remodeling of the right coronary artery was also evaluated. In total, 625 arterial segments were analyzed. At 12-month follow-up, the plaque burden had increased slightly by 0.34% (interquartile range [IQR], −4.32% to 6.35%; P=0.02), and the plaque volume was not significantly changed (0.33 mm3; IQR, −3.05 to 3.54; P=0.213). The minimum luminal area decreased 0.05 mm2 (IQR, −1.33 to 0.87 mm2; P=0.012), and this was accompanied by vessel reduction, as evidenced by negative remodeling in 43% of the 625 segments. We conclude that serial computed tomographic angiography can be used to quantitatively evaluate the morphologic progression of coronary plaques.

Occlusive disease confined to the right coronary artery: Clinical features, surgical treatment and long-term follow-up in 124 patients

1979 ◽  
Vol 43 (6) ◽  
pp. 1103-1108 ◽  
Author(s):  
Michele A. Codini ◽  
Philip W. Hassan ◽  
Robert G. Hauser ◽  
Marshall D. Goldin ◽  
Joseph V. Messer
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Clinical Features ◽  
Right Coronary Artery ◽  
Occlusive Disease ◽  
Long Term Follow Up ◽  
The Right

scholarly journals Short-term assessment of radial artery grafts with multidetector computed tomography

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
En Qiao ◽  
Yuetang Wang ◽  
Jun Yu ◽  
Xu Wang ◽  
Xinjin Luo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Radial Artery ◽  
Right Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Graft Patency ◽  
Short Term ◽  
The Right

Abstract Background The clinical use of the radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines. Multidetector computed tomography (MDCT) is widely used to evaluate graft patency, as invasive coronary angiography could cause potentially serious risks including bleeding, dissection and stroke. This study aims to report the short-term results of the RA in CABG with MDCT. Methods The study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2017 to 2018, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis. Results A total of 150 grafts were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. Graft patency of the left internal mammary artery was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of the saphenous vein graft of 81.1% (30/37). And the RA anastomosed to the left coronary artery system might have better patency than the RA anastomosed to the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686). Conclusions The short-term patency rate of RA grafts is good, and the RA might be associated with better patency when anastomosed to the left but not the right coronary artery. MDCT could provide excellent visualization of grafts in CABG.

Transabdominal Off-Pump Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery

2005 ◽  
Vol 1 (1) ◽  
pp. 32-34
Author(s):  
Giuseppe Tavilla
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Gastroepiploic Artery ◽  
Bypass Grafting ◽  
Transabdominal Approach ◽  
Off Pump ◽  
Right Gastroepiploic Artery ◽  
Hospital Morbidity ◽  
The Right

Background Anastomosis of the right gastroepiploic artery to vessels of the inferior wall of the heart can be performed using a transabdominal approach without sternotomy and without cardiopulmonary bypass. Methods From July 1999 to December 2004, 18 patients presenting with only right coronary artery disease were operated on by the transabdominal approach using a pedicled right gastroepiploic artery graft. In 14 patients, it was a redo operation. In all redo patients, a patent graft to the anterior wall was present. Median EuroSCORE was 5 (range 1–13). The right descending posterior artery was grafted in 10 patients, the right coronary artery in 8 patients. Results There was no hospital mortality and no conversion to sternotomy. Hospital morbidity consisted only of a right pleural hemothorax and a superficial wound infection. No blood transfusion was necessary in 16 (89%) patients. Hospital stay averaged 6 days. Follow-up is complete and averaged 2 years (range 0.5–5.5 years). There was no late mortality. Seventeen patients (94%) were asymptomatic. One patient who experienced return of angina 1 year after the procedure underwent a percutaneous transluminal coronary angioplasty of the right coronary artery. Thirteen patients underwent a stress test at median follow-up of 14 months without signs of myocardial ischemia. Conclusions Off-pump coronary bypass grafting using a right gastroepiploic artery by the transabdominal approach is a safe and effective procedure with a low hospital morbidity and excellent follow-up. In redo operations, this technique excludes the risk of damaging patent grafts to the left coronary system.

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