Anomalous origin of the left main coronary artery: anatomical correction and concomitant LIMA-to-LAD grafting1 (original) (raw)

Anomalous origin of the left main coronary artery: anatomical correction and concomitant LIMA-to-LAD grafting

European Journal of Cardio-Thoracic Surgery, 1999

A 55-year-old woman with angina pectoris and exertional dyspnea underwent surgical correction of an anomalous left main coronary artery (LMCA) originating from the right sinus of Valsalva. During the operation, the roof of the intramurally coursing LMCA was opened into the aortic lumen, and a neo-coronary ostium was created by suturing the circumference of the LMCA intima to the aortic intima. In addition, a left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery anastomosis was performed. Postoperative coronary angiography demonstrated two independent, patent orifices of both the LMCA and the right coronary artery. The technique presented herein, of combined anatomical correction and LIMA-to-LAD grafting, is feasible and leads to distinct angiographic and clinical improvement.

Anomalous origin of the left main coronary artery: anatomical correction and concomitant LIMA-to-LAD grafting 1 Presented at the 12th Annual Meeting of the European Association for Cardiothoracic Surgery, Brussels, Belgium, September 20–23, 1998. 1

European Journal of Cardio-thoracic Surgery, 1999

A 55-year-old woman with angina pectoris and exertional dyspnea underwent surgical correction of an anomalous left main coronary artery (LMCA) originating from the right sinus of Valsalva. During the operation, the roof of the intramurally coursing LMCA was opened into the aortic lumen, and a neo-coronary ostium was created by suturing the circumference of the LMCA intima to the aortic intima. In addition, a left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery anastomosis was performed. Postoperative coronary angiography demonstrated two independent, patent orifices of both the LMCA and the right coronary artery. The technique presented herein, of combined anatomical correction and LIMA-to-LAD grafting, is feasible and leads to distinct angiographic and clinical improvement.

Anomalous Left Main Coronary Artery: Not Always a Simple Surgical Reimplantation

Cardiology and therapy, 2015

We present the case of 56-year-old woman who required complex coronary artery bypass grafting for high-risk anomalous left main coronary artery (LMCA) originating from right coronary cusp including conventional reimplantation of the LMCA plus left internal mammary artery (LIMA) graft to the left anterior descending (LAD) and saphenous vein graft (SVG) to the left circumflex (LCx). On subsequent cardiac computed tomography screening and cardiac catheterization, the LIMA graft was occluded after just a few centimeters, but the SVG graft was patent with good run-off into the native LCx and also filled the LAD retrogradely. The reimplanted left main stem demonstrated at least moderate ostial stenosis although pressure wire assessment of this was not significant (fractional flow reserve 0.89), probably due to good retrograde filling of the LAD from the SVG to LCx, therefore, we did not proceed with ostial LMCA stenting. She remains on yearly review with a low threshold for further revasc...

Repair of an anomalous left coronary artery

Cardiovascular Surgery, 2002

We describe a patient with an anomalous single coronary artery who presented with a syndrome of atypical chest pain. Coronary angiography revealed a single right coronary ostium, with a narrowed left coronary artery originating at the right coronary ostium. The proximal portion of the left coronary artery that was narrowed was noted to run in the aortic wall. We describe the operative management of this patient using ostial remodeling. 

Setting things “right”: right internal mammary artery on anomalous right coronary artery - a case report

Journal of International Medical Research, 2021

Anomalous aortic origin of a coronary artery (AAOCA) is a rare pathology that may cause episodic ischemia owing to possible vessel compression during systolic expansion of the aortic root. This anomaly can lead to myocardial infarction, malignant arrhythmias and sudden cardiac death (SCD). Several surgical techniques have been described; however, there are no defined guidelines regarding the treatment of AAOCA. We report the case of a 47-year-old woman with ectopic origin of the right coronary artery (RCA) from the left sinus of Valsalva, with an interarterial course of the proximal segment of the artery, running between the aorta and the pulmonary trunk. Revascularization was accomplished by harvesting the right internal mammary artery (RIMA) and anastomosing it to the anomalous RCA, given the small portion of the RCA following an intramural course and our familiarity with the procedure. The RCA was ligated proximal to the anastomosis to avoid the string sign phenomenon. This proce...

Aberrant origin of the right coronary artery: diagnostic and surgical aspects

European Journal of Cardio-Thoracic Surgery, 1996

A 43-year-old man with angina for 15 years underwent coronary angiography, which showed an anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva with a 30-40% fibrous stenosis in the proximal part of the artery, which was presumably responsible for the patient's symptoms. Myocardial scintigraphy (Tc-99 m Cardiolite) suggested reversible ischemia at the apex and the posterior wall of the ventricles. After coronary bypass and anastomosis of the right internal mammary artery (RIMA) to the middle segment of RCA, the patient was asymptomatic; however, a postoperative myocardial scintigraphy indicated that the myocardial ischemia was irreversible.

Right internal mammary artery for the management of anomalous right coronary artery from the left sinus of Valsalva; a case report

The Egyptian Cardiothoracic Surgeon

Background: Anomalous origin of the right coronary artery from the left sinus of Valsalva (ARCA) is a rare anomaly. Surgery is recommended in symptomatic patients, while the optimal surgical approach is controversial. Case presentation: We present a case of an ARCA in a 56-year-old male who was managed with coronary artery bypass grafting using the right internal mammary artery and ligation of the proximal right coronary artery. The patient remained asymptomatic after 1 year of follow-up. Conclusions: ARCA can be managed using the right internal mammary artery with ligation of the proximal right coronary artery to prevent the competitive flow.

Coronary angioplasty of anomalous right coronary arteries

Catheterization and Cardiovascular Diagnosis, 1993

We report 2 cases of successful angioplasty of anomalous right coronary arteries originating above the sinotubular line at the junction of the right and left sinus of Valsalva. The use of Amplatz left guiding catheters provided optimal support for performing angioplasty. o 1993 wiiey-Liss, inc.

Anomalous Left Coronary Artery: Modified Direct Aortic Implantation

Asian Cardiovascular and Thoracic Annals, 2003

The technique of direct transfer of an anomalous left coronary artery from the pulmonary artery to the aorta was modified. Using part of the lateral and anterior wall of the pulmonary artery as a flap in continuity with the coronary button as part of the transfer, a tension-free anastomosis is possible. This technique was employed in 3 consecutive infants, with good outcome.