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[Coronary artery bypass grafting in two patients with single coronary artery]
O Izumiyama1, A Yamashita, S Sugimoto
1Hakodate Municipal Hospital, Department of Cardiovascular Surgery, Hokkaido, Japan.
Insights
Two patients with a single coronary artery underwent successful coronary artery bypass grafting (CABG) using arterial grafts. This rare condition, single coronary artery, can cause myocardial ischemia, requiring surgical intervention.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Single coronary artery (SCA) is a rare congenital anomaly where only one coronary artery arises from the aorta.
- SCA can lead to myocardial ischemia and infarction due to coronary stenosis or anomalies.
- Surgical management of SCA with coronary artery disease (CAD) presents unique challenges.
Observation:
- Two patients with Sharbaugh Type L-IIa SCA, originating from the left sinus and branching into LAD and LCx with RCA arising from the proximal LAD, were identified.
- Patient 1 presented with angina on exertion due to right coronary artery (RCA) stenosis.
- Patient 2 presented with inferior myocardial infarction due to left anterior descending (LAD) artery stenosis.
Findings:
- Successful coronary artery bypass grafting (CABG) was performed on both patients using arterial grafts.
- Right internal thoracic artery (RITA) was used for RCA bypass in both patients.
- Left internal thoracic artery (LITA) was used for LAD bypass in the second patient.
Implications:
- Coronary artery bypass grafting (CABG) is a viable and successful treatment for myocardial ischemia in patients with single coronary artery.
- Arterial grafts, such as RITA and LITA, provide effective revascularization in SCA patients.
- This case series highlights the importance of recognizing and managing SCA with CAD to prevent adverse cardiac events.
Abstract:
We experienced two patients with single coronary artery who underwent CABG using arterial grafts successfully. In two patients coronary angiography demonstrated a single coronary artery which was originated in left coronary sinus and was bifurcated to LAD and LCx, and then RCA branched off proximal LAD, passing in front of the right ventricular out flow tract (Sharbaugh Type L-IIa). To the first patient, a 52-year-old man who had angina on exertion due to long stenosis of RCA, CABG to RCA using RITA was carried out. To the second patient, a 57-year-old man who had inferior myocardial infarction due to 90% stenosis of proximal LAD, CABG to RCA using RITA and LAD using LITA was carried out. Single coronary artery without additional congenital cardiac anomalies may lead to myocardial ischemia, necessitating CABG as coronary reconstructions.