Clinical & Experimental Cardiology
Open Access

Abstract

Does Coronary Artery Bypass Surgery still have a Role in the Management of Patients with Anomalous Origin of the Right Coronary Artery from the Left Sinus of Valsalva?

Waleed I Ibraheem and Osama A Abass

Objective: An anomalous origin of the Right Coronary Artery (RCA) from the left sinus of Valsalva with an interarterial course is a rare congenital anomaly. We aimed to assess mid-term results after off-pump coronary artery bypass grafting for treatment of Anomalous right coronary artery arising from the left sinus of Valsalva.
Methods: Between the year 2008 and 2012, a total of 16 patients underwent off-pump CABG for treatment of the right coronary artery of an anomalous origin from the Left Sinus of Valsalva. Their details such as risk factors, operative details, and results of multi-slice coronary angiography follow-up were assessed.
Results: The mean age of these patients was 34.8 ± 4.68 years, and most of the patients were male (15/16: 93.75%). The patients received a mean of 1.5 ± 0.87 grafts. Closure of the RCA was completed for all patients except one who developed ischaemic symptoms upon closure of the proximal part of the RCA (15/16). We had one mortality. In the remaining patients, Symptoms persisted in 2/15 patients. The mean follow-up time was 63.4 ± 28.6 months. All patients had patent vessels on five years follow-up Multi-slice computed tomography scan except for one
patient who showed RCA graft occlusion on 1-year follow-up scan.
Conclusion: Off-pump CABG of RCA with anomalous origin can be done safely with excellent early and midterm results. Proximal RCA ligation is an essential step to the success of the CABG, but intraoperative challenge testing is required to confirm sufficiency of the ITA graft to re-perfuse the supplied territory.