PDF(Pubmed)
Abstract：
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.
METHODS: 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.
CONCLUSIONS: 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.
METHODS: 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.
CONCLUSIONS: 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.
摘要：
背景：右冠状动脉的异常起源和动脉间进程是一种罕见的异常，如果不及时治疗，可导致突然的缺血性心脏死亡。我们介绍了一例患者，该患者的右冠状动脉异常起源于左冠状窦，并通过使用合适的乳内动脉导管进行了冠状动脉搭桥手术。近端右冠状动脉结扎以防止竞争性流动。
方法：一名69岁男性，有10年间歇性胸痛和呼吸困难病史，检查结果阴性，接受了心导管检查，显示源自左冠状窦的异常右冠状动脉（RCA），升主动脉和肺动脉之间的动脉间通道，近端RCA变窄约70%。患者使用右乳内动脉（RIMA）作为导管进行了体外循环冠状动脉搭桥术，RCA的第2段是目标。近端RCA结扎。术中,没有缺血或心律失常的迹象。患者成功地从体外循环中取出，并最终出院回家。
结论：以乳内动脉为导管的冠状动脉搭桥手术可以成功治疗具有动脉间过程的右冠状动脉异常症状。近端右冠状动脉的结扎对于最大程度地减少通过旁路移植物的竞争流量至关重要。
方法：一名69岁男性，有10年间歇性胸痛和呼吸困难病史，检查结果阴性，接受了心导管检查，显示源自左冠状窦的异常右冠状动脉（RCA），升主动脉和肺动脉之间的动脉间通道，近端RCA变窄约70%。患者使用右乳内动脉（RIMA）作为导管进行了体外循环冠状动脉搭桥术，RCA的第2段是目标。近端RCA结扎。术中,没有缺血或心律失常的迹象。患者成功地从体外循环中取出，并最终出院回家。
结论：以乳内动脉为导管的冠状动脉搭桥手术可以成功治疗具有动脉间过程的右冠状动脉异常症状。近端右冠状动脉的结扎对于最大程度地减少通过旁路移植物的竞争流量至关重要。
