Thorac Cardiovasc Surg 2015; 63(05): 360-366
DOI: 10.1055/s-0034-1376256
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

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

Sang-Ho Cho
1   Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
2   Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, Chungbuk National University, Seoul, Republic of Korea
,
Hyun-Chel Joo
3   Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
,
Kyung-Jong Yoo
3   Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
,
Young-Nam Youn
3   Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

17 November 2013

04 March 2014

Publication Date:
09 June 2014 (online)

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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.