Anomalous right coronary artery managed with bypass and proximal ligation
Harry Ramcharran1, Ahmad Nazem2
1Department of Cardiothoracic Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA. ramcharh@upstate.edu.
Insights
An anomalous origin of the right coronary artery (RCA) can cause sudden cardiac death. Coronary artery bypass surgery using the internal mammary artery effectively treats this condition, with proximal RCA ligation preventing competitive flow.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Anomalies
Background:
- Anomalous origin and inter-arterial course of the right coronary artery (RCA) is a rare condition.
- This anomaly can lead to severe outcomes, including sudden ischemic cardiac death.
- Early diagnosis and appropriate management are crucial.
Background:
An anomalous origin and inter-arterial course of the right coronary artery is a rare anomaly that can lead to sudden ischemic cardiac death if left untreated. We present a case of a patient with an anomalous right coronary artery originating from the left coronary sinus and an inter-arterial course that was managed with coronary artery bypass surgery using a suitable internal mammary artery conduit. The proximal right coronary artery was ligated to prevent competitive flow.
Case Presentation:
A 69 year-old-male with a ten-year history of intermittent chest pain and dyspnea with a negative workup underwent a cardiac catheterization, which showed an anomalous right coronary artery (RCA) originating from the left coronary sinus, with an inter-arterial course between the ascending aorta and pulmonary artery, and approximately 70% narrowing of the proximal RCA. The patient underwent an on-pump coronary artery bypass using the right internal mammary artery (RIMA) as a conduit, with segment 2 of the RCA being the target. The proximal RCA was ligated. Intra-operatively, there were no signs of ischemia or arrhythmia. The patient was successfully taken off cardiopulmonary bypass and eventually discharged home.
Conclusion:
Symptomatic anomalous origin of the right coronary artery with an inter-arterial course can be treated successfully with coronary artery bypass surgery with the internal mammary artery as a conduit. Ligation of the proximal right coronary artery is essential to minimize competitive flow through the bypass graft.
