Case Report
Surgical Unroofing of an Anomalous Right Coronary Artery Arising From the Posterior Left Sinus of Valsalva
World Journal for Pediatric and Congenital Heart Surgery 4(4) 433-435 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150135113491121 pch.sagepub.com
Yacine Elhmidi, MD1, Christian No¨bauer, MD1, Ju¨rgen Ho¨rer, MD1, Christian Schreiber, MD, PhD1, and Rudiger Lange, MD, PhD1
Abstract A 25-year-old male patient presented with sudden collapse due to a cardiac arrest during physical exercise. An electrocardiogram revealed ST-T wave abnormalities. A coronary catheterization and complementary computer tomography angiography showed an anomalous right coronary artery arising from the posterior left sinus of Valsalva. A successful surgical unroofing was performed. Keywords coronary artery anomaly, coronary artery surgery, congenital heart surgery, cardiopulmonary bypass Submitted March 24, 2013; Accepted April 29, 2013.
Case Presentation A 25-year-old male patient presented after a sudden collapse at physical exercise. Cardiac monitoring showed ventricular fibrillation. After defibrillating shocks, circulation was restored along with palpable pulses and blood pressure. The patient had no cardiac history. Also, no prior pulmonary, endocrine, or seizure history was reported. The electrocardiogram revealed nonspecific ST-T wave abnormalities. Upon coronary catheterization, the right coronary artery (RCA) could not be intubated in the usual fashion. Subsequently, a computer tomography (CT) angiography was performed. It showed an RCA originating from the posterior left sinus of Valsalva, wedged between aortic root and pulmonary outflow tract (Figure 1). After aortotomy, the anomalous course of the RCA was identified using a 1.5-mm probe (Figure 2). The intramural course was unroofed by excising the common wall between the aorta and the RCA superior to the commissure. Now, the new created ostium was located in the right coronary sinus. Finally, the aortotomy was closed with autologous pericardium. The postoperative CT angiography confirmed the results (Figure 3). Patient’s recovery was uneventful. One year after the procedure, the patient had no symptoms at rest and at exercise.
cases were reported by White and Edwards in 1984.2 Caitman et al reported a series of 31 patients, including 7 of them with RCA anomalies. Other studies described a higher incidence of this anomaly ranging from 0.6% in the Turkish population3 to 0.25% in the Japanese.4 Most of the patients exhibited a cardiac arrest at physical exercise. Also, angina pectoris, myocardial infarction,5,6 or even sudden deaths is reported.7,8 Moreover, young age (
Surgical Unroofing of an Anomalous Right Coronary Artery Arising From the Posterior Left Sinus of Valsalva
World Journal for Pediatric and Congenital Heart Surgery 4(4) 433-435 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2150135113491121 pch.sagepub.com
Yacine Elhmidi, MD1, Christian No¨bauer, MD1, Ju¨rgen Ho¨rer, MD1, Christian Schreiber, MD, PhD1, and Rudiger Lange, MD, PhD1
Abstract A 25-year-old male patient presented with sudden collapse due to a cardiac arrest during physical exercise. An electrocardiogram revealed ST-T wave abnormalities. A coronary catheterization and complementary computer tomography angiography showed an anomalous right coronary artery arising from the posterior left sinus of Valsalva. A successful surgical unroofing was performed. Keywords coronary artery anomaly, coronary artery surgery, congenital heart surgery, cardiopulmonary bypass Submitted March 24, 2013; Accepted April 29, 2013.
Case Presentation A 25-year-old male patient presented after a sudden collapse at physical exercise. Cardiac monitoring showed ventricular fibrillation. After defibrillating shocks, circulation was restored along with palpable pulses and blood pressure. The patient had no cardiac history. Also, no prior pulmonary, endocrine, or seizure history was reported. The electrocardiogram revealed nonspecific ST-T wave abnormalities. Upon coronary catheterization, the right coronary artery (RCA) could not be intubated in the usual fashion. Subsequently, a computer tomography (CT) angiography was performed. It showed an RCA originating from the posterior left sinus of Valsalva, wedged between aortic root and pulmonary outflow tract (Figure 1). After aortotomy, the anomalous course of the RCA was identified using a 1.5-mm probe (Figure 2). The intramural course was unroofed by excising the common wall between the aorta and the RCA superior to the commissure. Now, the new created ostium was located in the right coronary sinus. Finally, the aortotomy was closed with autologous pericardium. The postoperative CT angiography confirmed the results (Figure 3). Patient’s recovery was uneventful. One year after the procedure, the patient had no symptoms at rest and at exercise.
cases were reported by White and Edwards in 1984.2 Caitman et al reported a series of 31 patients, including 7 of them with RCA anomalies. Other studies described a higher incidence of this anomaly ranging from 0.6% in the Turkish population3 to 0.25% in the Japanese.4 Most of the patients exhibited a cardiac arrest at physical exercise. Also, angina pectoris, myocardial infarction,5,6 or even sudden deaths is reported.7,8 Moreover, young age (
