Coronary Artery Bypass Grafting for Anomalous RCA From LAD With Proximal LAD Stenosis
YuMing Hao1, Jia Li1, SiChong Qian1
1Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.
Background:
An anomalous right coronary artery (RCA) from the left anterior descending artery (LAD) is rare.
Case Summary:
A 63-year-old man with exertional epigastric discomfort had an RCA from the mid-LAD, severe proximal LAD stenosis upstream from the anomalous takeoff, LAD-RCA bifurcation disease, and obtuse marginal disease. The heart team selected coronary artery bypass grafting (CABG) to avoid shared-inflow jeopardy and achieve complete revascularization. Grafting used left internal mammary artery-LAD, sequential saphenous vein graft-diagonal branch-first obtuse marginal, and saphenous vein graft-anomalous RCA; recovery was uncomplicated.
Discussion:
Severe proximal LAD stenosis can threaten both LAD and RCA territories in this anatomy. Multimodality imaging guided individualized CABG.
Take-Home Messages:
Proximal LAD stenosis in anomalous RCA-from-LAD anatomy can create shared LAD-RCA inflow risk. Coronary computed tomographic angiography and angiography define the anomalous course and procedural hazards; CABG can restore independent inflow in complex multivessel disease.
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