Anomalous right coronary artery from the left sinus: a minimally invasive approach

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Minimally Invasive Cardiac Surgery

Background:

• Anomalous right coronary artery arising from the left sinus (ARCA) is a critical cause of sudden cardiac death, especially in young athletes.
• Surgical intervention is indicated for symptomatic adult patients or those with exercise-induced myocardial ischemia.
• Current surgical options include coronary artery bypass grafting (CABG) and anatomic correction (ostium unroofing or reimplantation).

Purpose of the Study:

• To describe the rationale and technique of a minimally invasive right thoracotomy approach for ARCA correction.
• To evaluate the safety and efficacy of this novel surgical method.

Main Methods:

• Retrospective review of 17 patients with anomalous coronary origin from the opposite sinus of Valsalva between March 2008 and September 2010.
• Detailed description of a minimally invasive technique in four adult ARCA patients using a right anterior thoracotomy.
• Procedure involved right internal mammary artery (RIMA) to right coronary artery (RCA) bypass with proximal RCA ligation, performed under direct vision without cardiopulmonary bypass.

Main Results:

• Four adult patients (2 male, 2 female; mean age 55.3 years) underwent the procedure.
• Presenting symptoms included chest pain, syncope, dyspnea, and palpitations; two had positive preoperative stress tests for ischemia.
• Mean follow-up of 14 months (range 5-37 months) showed all patients were alive and asymptomatic.

Conclusions:

• Minimally invasive right thoracotomy is a viable surgical option for ARCA.
• This approach demonstrates good early and midterm clinical outcomes for patients with anomalous right coronary artery.