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Aortic valve replacement in a patient with an aberrant left coronary artery
Ahmed A Alsaddique1, Mohammed M Elsaegh, Mohammed A Fouda
1Division of Cardiac Surgery, College of Medicine and King Khalid University Hospital, PO Box 7805, Riyadh 11472, Saudi Arabia. alsadd@ksu.edu.sa
Insights
A rare coronary anomaly, a left main coronary artery originating from the noncoronary cusp, complicated aortic valve replacement. Bypass grafting successfully restored coronary flow, enabling patient weaning from cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Cardiac Anatomy
Background:
- Aortic valve replacement is a common procedure.
- Congenital coronary anomalies can present during cardiac surgery.
- Anatomical variations require careful surgical planning.
Observation:
- A 22-year-old male had anomalous left coronary ostium originating from the noncoronary cusp near the annulus during aortic valve replacement.
- Post-operative weaning from cardiopulmonary bypass was unsuccessful.
- A Teflon pledget was initially suspected of obstructing the left coronary ostium.
Findings:
- The patient's inability to wean from cardiopulmonary bypass was due to the anomalous coronary artery origin.
- Surgical intervention involved bypass grafting to the left coronary system.
- Successful bypass grafting resolved the obstruction and facilitated weaning from cardiopulmonary bypass.
Implications:
- This case highlights the importance of identifying coronary anomalies during aortic valve surgery.
- Anomalous coronary artery origins can lead to intraoperative and postoperative complications.
- Prompt diagnosis and surgical correction, such as bypass grafting, are crucial for patient outcomes.
Abstract:
A 22-year-old male undergoing aortic valve replacement was found to have the left coronary ostium arising from the noncoronary cusp area in close proximity to the annulus. He could not be weaned off cardiopulmonary bypass after the operation, even after removal of a Teflon pledget thought to obstruct the left coronary ostium. He underwent bypass grafting to the left coronary system and was then easily weaned off cardiopulmonary bypass.