Totally occluded grafted right internal mammary artery to anomalously originated right coronary artery
Hyukjin Park1, Young Joon Hong1, Seunghun Lee1
1Division of Cardiology of Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea.
Insights
Anomalous aortic origin of a coronary artery requires surgery when symptomatic. Graft occlusion can occur due to competitive native flow, suggesting a need for advanced hemodynamic assessment.
Area of Science:
- Cardiovascular Surgery
- Congenital Heart Disease
- Interventional Cardiology
Background:
- Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart defect.
- Surgical intervention is typically recommended for symptomatic patients with AAOCA.
- This case involves a right coronary artery originating from the left coronary sinus.
Observation:
- A 21-year-old male presented with symptomatic AAOCA.
- Coronary artery bypass graft (CABG) surgery was performed due to stenosis from external compression.
- The bypass graft occluded one year post-surgery.
Findings:
- The anomalous coronary artery experienced significant stenosis due to extrinsic compression between the aorta and pulmonary artery.
- Postoperative graft occlusion was observed one year after CABG.
- Dynamic stenosis and competitive antegrade flow from the native artery likely contributed to graft failure.
Implications:
- Dynamic stenosis in AAOCA can compromise bypass graft patency.
- Evaluating native coronary artery flow dynamics and pressures may aid surgical decision-making.
- Further research into hemodynamic assessment for AAOCA is warranted to improve surgical outcomes.
Abstract:
An anomalous aortic origin of a coronary artery is rare and surgical intervention is recommended when the patient is symptomatic. We performed coronary artery bypass graft surgery in a 21-year-old male patient with a right coronary artery anomalously originating from the left coronary sinus. The artery was significantly stenosed by external compression between the aorta and the pulmonary artery. However, the graft became occluded 1 year after the operation. In such cases, the dynamic nature of the stenosis can cause relatively intact antegrade competitive flow from the native coronary artery and lead to an occlusion of the grafted artery. Methods for evaluating flow rates or intraluminal pressures of native arteries could be helpful in decision-making in similar cases.
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