Anomalous Origin of Right Coronary Artery in Subaortic Position Michele Gallo, MD, Vladimiro L. Vida, MD, PhD, and Giovanni Stellin, MD Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
Fig 2.
FEATURE ARTICLES
Fig 1.
Fig 3.
A
n 18-year-old man was symptomatic for easy fatigability, and on two-dimensional echocardiographic examination he had significant subaortic diastolic flow into a dilated left ventricle (left ventricular end-diastolic diameter of 62 mm). On myocardial stress perfusion scan, the patient had hypoperfusion of the inferiormedial segment of the left ventricle (LV). At threedimensional cardiac computed tomography scan and angiography, we demonstrated a gigantic right coronary artery (RCA; Figs 1–3, black asterisk indicates the origin of Address correspondence to Dr Vida, Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Via Giustiniani, 2- 35100 Padua, Italy; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Fig 4.
the RCA) originating in the subaortic position (Ao, aorta) with a significant intercoronary communication with the left coronary artery (LCA; Figs 2, 3, white arrows). The patient underwent a successful surgical closure of the subaortic coronary ostium, which was done through the aortic valve, to avoid further coronary steal and the progression of LV dilation. The first aneurysmatic portion of the RCA was then anastomosed in a laterolateral fashion using 6-0 Prolene running suture to the right sinus of Valsalva to reestablish a physiologic bicoronary circulation (Fig 4, white asterisk indicates the sinus of Valsalva, black arrow indicates the RCA). The postoperative course was uneventful, and the patient was discharged home on postoperative day 8 on oral aspirin (100 mg/day) and clopidogrel (75 mg/day). Ann Thorac Surg 2015;99:2222 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.02.115
Fig 2.
FEATURE ARTICLES
Fig 1.
Fig 3.
A
n 18-year-old man was symptomatic for easy fatigability, and on two-dimensional echocardiographic examination he had significant subaortic diastolic flow into a dilated left ventricle (left ventricular end-diastolic diameter of 62 mm). On myocardial stress perfusion scan, the patient had hypoperfusion of the inferiormedial segment of the left ventricle (LV). At threedimensional cardiac computed tomography scan and angiography, we demonstrated a gigantic right coronary artery (RCA; Figs 1–3, black asterisk indicates the origin of Address correspondence to Dr Vida, Pediatric and Congenital Cardiac Surgery Unit, Department of Thoracic, Cardiac and Vascular Sciences, University of Padua, Via Giustiniani, 2- 35100 Padua, Italy; e-mail: [email protected].
Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Fig 4.
the RCA) originating in the subaortic position (Ao, aorta) with a significant intercoronary communication with the left coronary artery (LCA; Figs 2, 3, white arrows). The patient underwent a successful surgical closure of the subaortic coronary ostium, which was done through the aortic valve, to avoid further coronary steal and the progression of LV dilation. The first aneurysmatic portion of the RCA was then anastomosed in a laterolateral fashion using 6-0 Prolene running suture to the right sinus of Valsalva to reestablish a physiologic bicoronary circulation (Fig 4, white asterisk indicates the sinus of Valsalva, black arrow indicates the RCA). The postoperative course was uneventful, and the patient was discharged home on postoperative day 8 on oral aspirin (100 mg/day) and clopidogrel (75 mg/day). Ann Thorac Surg 2015;99:2222 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2015.02.115
