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

  • Ali Refatllari Department of Cardiovascular Surgery, University Hospital Centre “Mother Theresa”, Rruga e Dibres, N. 370, Tirana
  • Ermal Likaj Department of Cardiovascular Surgery, University Hospital Centre “Mother Theresa”, Rruga e Dibres, N. 370, Tirana
  • Selman Dumani Department of Cardiovascular Surgery, University Hospital Centre “Mother Theresa”, Rruga e Dibres, N. 370, Tirana
  • Endri Hasimi Department of Cardiovascular Surgery, University Hospital Centre “Mother Theresa”, Rruga e Dibres, N. 370, Tirana
  • Artan Goda Department of Cardiovascular Surgery, University Hospital Centre “Mother Theresa”, Rruga e Dibres, N. 370, Tirana
Keywords: Coronary anomalies, right coronary artery, bypass grafting, mitral stenosis, surgical technique

Abstract

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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References

Davies JE, Burkhart HM, Dearani JA, et al. Surgical management of anomalous aortic origin of a coronary artery. Ann Thorac Surg. 2009;88:844–848.

http://dx.doi.org/10.1016/j.athoracsur.2009.06.007

PMid:19699909

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;85:2135–2136.

http://dx.doi.org/10.1016/j.athoracsur.2007.07.006

PMid:18498845

Erez E, Tam VKH, Doublin NA, Stakes J. Anomalous coronary artery with aortic origin and course between the great arteries: Improved diagnosis, anatomic findings, and surgical treatment. Ann Thorac Surg. 2006;82:973–977.

http://dx.doi.org/10.1016/j.athoracsur.2006.04.089

PMid:16928518

Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35:1493–1501.

http://dx.doi.org/10.1016/S0735-1097(00)00566-0

Borjesson M, Pelliccia A. Incidence and aetiology of sudden death in young athletes: an international perspective. Br J Sports Med. 2009;43:644–648.

http://dx.doi.org/10.1136/bjsm.2008.054718

PMid:19734497

Mainwaring RD, Reddy VM, Reinhartz O, Petrossian E, MacDonald M, Nasirov T, Miyake CY, Hanley FL. Anomalous aortic origin of a coronary artery: medium-term results after surgical repair in 50 patients. Ann Thorac Surg. 2011;92(2):691-7.

http://dx.doi.org/10.1016/j.athoracsur.2011.03.127

PMid:21718962

Taylor AJ, Rogan KM, Virmani. R Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992;20(3):640-7.

http://dx.doi.org/10.1016/0735-1097(92)90019-J

Kaku B, Kanaya H, Ikeda M, Uno Y, Fujita S, Kato F, Oka T. Acute inferior myocardial infarction and coronary spasm in a patient with an anomalous origin of the right coronary artery from the left sinus of valsalva. Jpn Circ J. 2000;64(8):641-3.

http://dx.doi.org/10.1253/jcj.64.641

PMid:10952167

Heo W, Min HK, Kang do K, Jun HJ, Hwang YH, Lee HC. Three different situations and approaches in the management for anomalous origin of the right coronary artery from the left coronary sinus: case report. J Cardiothorac Surg. 201423;9:21.

Pe-alver JM, Mosca RS, Weitz D, Phoon CK. Anomalous aortic origin of coronary arteries from the opposite sinus: a critical appraisal of risk. BMC Cardiovasc Disord. 2012;12:83.

http://dx.doi.org/10.1186/1471-2261-12-83

PMid:23025810 PMCid:PMC3502461

Jureidini SB, Singh GK, Marino CJ, Fiore AC. Aberrant origin of the left coronary artery from the right aortic sinus: surgical intervention based on echocardiographic diagnosis. J Am Soc Echocardiogr. 2000;13:1117-1120.

http://dx.doi.org/10.1067/mje.2000.107072

PMid:11119280

Frommelt PC, Sheridan DC, Berger S, Frommelt MA, Tweddell JS. Ten-year experience with surgical unroofing of anomalous aortic origin of a coronary artery from the opposite sinus with an interarterial course. J Thorac Cardiovasc Surg. 2011;142(5):1046-51.

http://dx.doi.org/10.1016/j.jtcvs.2011.02.004

PMid:21439578

John S, Strickman NE. Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus. Tex Heart Inst J. 2002;29(1):37–39.

Mumtaz MA, Lorber RE, Arruda J, Pettersson GB, Mavroudis C. Surgery for Anomalous Aortic Origin of the Coronary Artery. Ann Thorac Surg. 2011;91:811-815.

http://dx.doi.org/10.1016/j.athoracsur.2010.11.002

PMid:21353004

Moodie DS, Gill C, Loop FD, Sheldon WC. Anomalous left main coronary artery originating from the right sinus of Valsalva: Pathophysiology, angiographic definition, and surgical approaches. J Thorac Cardiovasc Surg. 1980;80:198-205.

PMid:7401670

Selig MB, Jafari N. Anomalous origin of the left main coronary artery from the right coronary artery ostium-interarterial subtype: angiographic definition and surgical treatment. Cathet Cardiovasc Diagn. 1994;31:41-47.

http://dx.doi.org/10.1002/ccd.1810310110

Tavaf-Motamen H, Bannister SP, Corcoran C, Stewart RW, Mulligan CR, DeVries WC. Repair of anomalous origin of right coronary artery from the left sinus of valsalva. Ann Thorac Surg. 2008;85:2135-213.

http://dx.doi.org/10.1016/j.athoracsur.2007.07.006

PMid:18498845

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;29:299-307.

PMid:12484614 PMCid:PMC140292

Friedman AH, Fogel MA, Stephens P Jr, Hellinger JC, Nykanen DG, Tweddell J, Feltes TF, Rome JJ. Identification, imaging, functional assessment and management of congenital coronary arterial abnormalities in children. Cardiol Young. 2007;17(Suppl 2):56-67.

http://dx.doi.org/10.1017/S1047951107001163

PMid:18039399

Rogers 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;78:1829-1831.

http://dx.doi.org/10.1016/S0003-4975(03)01501-7

Frommelt PC, Frommelt MA, Tweddell JS, Jaquiss RDB. Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course. J Am Coll Cardiol. 2003;42:148-154.

http://dx.doi.org/10.1016/S0735-1097(03)00503-5

Karl TR, Provenzano SC, Nunn GR. Anomalous aortic origin of a coronary artery: a universally applicable surgical strategy. Cardiol Young. 2010;20:44-49.

http://dx.doi.org/10.1017/S1047951110001083

PMid:21087559

Rodefeld MD, Culbertson CB, Rosenfeld HM, Hanley FL, Thompson LD. Pulmonary artery translocation: a surgical option for complex anomalous coronary artery anatomy. Ann Thorac Surg. 2001;72:2150-2152.

http://dx.doi.org/10.1016/S0003-4975(01)03208-8

Tavaf-Motamen H, Bannister SP, Corcoran C, Stewart RW, Mulligan CR, DeVries WC. Repair of anomalous origin of right coronary artery from the left sinus of valsalva. Ann Thorac Surg. 2008;85:2135-2136.

http://dx.doi.org/10.1016/j.athoracsur.2007.07.006

PMid:18498845

Romp RL, Herlong JR, Landolfo CK, Sanders SP, Miller CE, Ungerleider RM, Jaggers J. Outcome of unroofing procedure for repair of anomalous origin of left or right coronary artery. Ann Thorac Surg. 2003;76:589-596.

http://dx.doi.org/10.1016/S0003-4975(03)00436-3

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. J Thorac Cardiovasc Surg. 1981;82:297-300.

PMid:7253693

Published
2015-12-23
How to Cite
1.
Refatllari A, Likaj E, Dumani S, Hasimi E, Goda A. Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis. Open Access Maced J Med Sci [Internet]. 2015Dec.23 [cited 2020Dec.5];4(1):131-4. Available from: https://www.id-press.eu/mjms/article/view/oamjms.2016.002
Section
C- Case Reports