[Anomalous origin of the right coronary artery from the ascending aorta]

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Congenital Heart Disease

Background:

• Coronary artery anomalies are rare congenital conditions with an approximate incidence of 1%.
• Anomalous origin of the right coronary artery from the ascending aorta is exceptionally rare, particularly at a significant distance from the sinotubular junction.
• These anomalies can lead to serious complications, impacting outcomes after open-heart surgery.

Observation:

• A 77-year-old male patient undergoing off-pump coronary artery bypass (OPCAB) for unstable angina.
• Intraoperative epiaortic echocardiography revealed an anomalous origin of the right coronary artery from the ascending aorta, 4 cm above the sinotubular junction.
• The anomalous right coronary artery coursed through the intended proximal anastomosis site for the saphenous vein graft (SVG).

Findings:

• The epiaortic ultrasound successfully identified the anomalous coronary artery origin before graft anastomosis.
• Failure to diagnose this anomaly preoperatively could have resulted in iatrogenic injury to the right coronary artery during the bypass procedure.
• The case reaffirms the critical role of intraoperative epiaortic echocardiography in detecting coronary artery anomalies.

Implications:

• Preoperative identification of anomalous coronary artery origins is crucial for surgical planning and patient safety.
• Epiaortic echocardiography serves as a valuable tool in preventing surgical complications associated with coronary artery anomalies.
• Consideration of rare coronary artery variations is essential in the preoperative evaluation for cardiac surgery to ensure optimal patient prognosis.