Anomalous Origin of Right Coronary Artery from Left Coronary Sinus: Surgical Management and Clinical Result

 

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Abstract

Background Anomalous aortic origin of coronary artery is a rare congenital condition in which the coronary artery arises from the opposite sinus of Valsalva. Although many patients are asymptomatic at the time of presentation or diagnosis, surgical correction is recommended due to the risk of ischemic sudden death. We describe seven cases of right coronary artery (RCA) arising from the left sinus of Valsalva, causing the hypoperfusion through RCA.

Patients and Methods All patients underwent preoperative coronary angiography, echocardiography, and cardiac stress test (treadmill test [TMT], n = 4; technetium-99m sestamibi [MIBI], n = 3). In four patients, coronary computed tomography (CT) was performed. On the basis of preoperative test results, unroofing of the coronary artery (n = 3) or off-pump coronary artery bypass (OPCAB; n = 4; patients with coronary arterial occlusive disease) was performed. In two patients, intraoperative flow meter was performed and showed the improvement of flow rate through RCA.

Results Postoperative CT angiography after OPCAB confirmed good graft patency (n = 4); CT angiography after unroofing demonstrated widely patent neo-orifice (n = 3). All patients underwent postoperative cardiac stress tests including TMT and MIBI, which revealed no evidence of ischemia. All patients were asymptomatic and returned to normal activities (mean follow-up, 41 months; 32–49 months).

Conclusion The appropriate surgical procedure based on specific anatomical details, perioperative evaluation, and follow-up by focusing on the ischemia may lead to successful surgical outcomes of this coronary anomaly.

• References

• 1 Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation 2007; 115 (10) 1296-1305
  PubMedGoogle Scholar
• 2 Davies JE, Burkhart HM, Dearani JA , et al. Surgical management of anomalous aortic origin of a coronary artery. Ann Thorac Surg 2009; 88 (3) 844-847 , discussion 847–848
  CrossrefPubMedGoogle Scholar
• 3 García-Rinaldi R, Sosa J, Olmeda S, Cruz H, Carballido J, Quintana C. Surgical treatment of right coronary arteries with anomalous origin and slit ostium. Ann Thorac Surg 2004; 77 (5) 1525-1529
  CrossrefPubMedGoogle Scholar
• 4 Hamzeh G, Crespo A, Estarán R, Rodríguez MA, Voces R, Aramendi JI. Anomalous origin of right coronary artery from left coronary sinus. Asian Cardiovasc Thorac Ann 2008; 16 (4) 305-308
  CrossrefPubMedGoogle Scholar
• 5 Eckart RE, Jones IV SO, Shry EA, Garrett PD, Scoville SL. Sudden death associated with anomalous coronary origin and obstructive coronary disease in the young. Cardiol Rev 2006; 14 (4) 161-163
  CrossrefPubMedGoogle Scholar
• 6 Maron BJ. Sudden death in young athletes. N Engl J Med 2003; 349 (11) 1064-1075
  CrossrefPubMedGoogle Scholar
• 7 Tavaf-Motamen H, Bannister SP, Corcoran PC, Stewart RW, Mulligan CR, DeVries WC. Repair of anomalous origin of right coronary artery from the left sinus of Valsalva. Ann Thorac Surg 2008; 85 (6) 2135-2136
  CrossrefPubMedGoogle Scholar
• 8 Lee MK, Choi JB, Kim KH, Kim KS. Surgery for anomalous origin of the left main coronary artery from the right sinus of Valsalva, in association with left main stenosis. Tex Heart Inst J 2009; 36 (4) 309-312
  PubMedGoogle Scholar
• 9 Gulati R, Reddy VM, Culbertson C , et al. Surgical management of coronary artery arising from the wrong coronary sinus, using standard and novel approaches. J Thorac Cardiovasc Surg 2007; 134 (5) 1171-1178
  CrossrefPubMedGoogle Scholar
• 10 Furukawa K, Itoh T. Direct coronary reimplantation for repair of anomalous aortic origin of left or right coronary artery. Ann Thorac Surg 2005; 79 (1) 389-390, author reply 390
  PubMedGoogle Scholar
• 11 Adachi I, Kagisaki K, Yagihara T , et al. Unroofing aortic intramural left coronary artery arising from right pulmonary artery. Ann Thorac Surg 2008; 85 (2) 675-677
  CrossrefPubMedGoogle Scholar
• 12 Fedoruk LM, Kern JA, Peeler BB, Kron IL. Anomalous origin of the right coronary artery: right internal thoracic artery to right coronary artery bypass is not the answer. J Thorac Cardiovasc Surg 2007; 133 (2) 456-460
  CrossrefPubMedGoogle Scholar
• 13 Rogers Jr SO, Leacche M, Mihaljevic T, Rawn JD, Byrne JG. Surgery for anomalous origin of the right coronary artery from the left aortic sinus. Ann Thorac Surg 2004; 78 (5) 1829-1831
  CrossrefPubMedGoogle Scholar
• 14 Angelini P. Coronary artery anomalies—current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex Heart Inst J 2002; 29 (4) 271-278
  PubMedGoogle Scholar
• 15 Frazier AA, Qureshi F, Read KM, Gilkeson RC, Poston RS, White CS. Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings. Radiographics 2005; 25 (4) 881-896
  CrossrefPubMedGoogle Scholar
• 16 Cerrito PB, Koenig SC, VanHimbergen DJ, Jaber SF, Ewert DL, Spence PA. Neural network pattern recognition analysis of graft flow characteristics improves intra-operative anastomotic error detection in minimally invasive CABG. Eur J Cardiothorac Surg 1999; 16 (1) 88-93
  CrossrefPubMedGoogle Scholar
• 17 Tokuda Y, Song MH, Oshima H, Usui A, Ueda Y. Predicting midterm coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg 2008; 86 (2) 532-536
  CrossrefPubMedGoogle Scholar
• 18 Reul RM, Cooley DA, Hallman GL, Reul GJ. Surgical treatment of coronary artery anomalies: report of a 37 1/2-year experience at the Texas Heart Institute. Tex Heart Inst J 2002; 29 (4) 299-307
  PubMedGoogle Scholar
• 19 Sabik III JF, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM. Does competitive flow reduce internal thoracic artery graft patency?. Ann Thorac Surg 2003; 76 (5) 1490-1496 , discussion 1497
  CrossrefPubMedGoogle Scholar
• 20 Mustafa I, Gula G, Radley-Smith R, Durrer S, Yacoub M. Anomalous origin of the left coronary artery from the anterior aortic sinus: a potential cause of sudden death. Anatomic characterization and surgical treatment. J Thorac Cardiovasc Surg 1981; 82 (2) 297-300
  CrossrefPubMedGoogle Scholar
• 21 Romp RL, Herlong JR, Landolfo CK , et al. Outcome of unroofing procedure for repair of anomalous aortic origin of left or right coronary artery. Ann Thorac Surg 2003; 76 (2) 589-595 , discussion 595–596
  CrossrefPubMedGoogle Scholar