The patient was a 77-year-old man. In June 2008, he underwent off-pump coronary artery bypass (OPCAB) for unstable angina Intraoperative epiaortic echo showed an anomalous origin of theright coronary artery from the ascending aorta 4 cm above the sinotubular junction (STJ). The right coronary artery traveled through the planned proximal anastomotic site of the saphenous vein graft (SVG). If diagnosis of the anomalous origin of the right coronary artery had not been made, there would have been a high likelihood that the right coronary artery could have been injured. Thus, the usefulness of epiaortic echo was reaffirmed. An anomalous origin of the coronary artery is a rare congenital anomaly and its incidence is approximately 1%. An anomalous origin of the right coronary artery is very rare from the ascending aorta 4 cm above the STJ and only a few cases have been reported. An anomalous origin of the coronary artery can cause serious complications affecting the prognosis after open heart surgery. Thus, such an anomalous origin needs to be considered in preoperative evaluation.
"An anomalous RCA with a high anterior take-off from ascending aorta is an uncommon and technically challenging vessel to cannulate . There are only a few reports in the literature describing this anomaly     . Some of them consider it as a " very rare " or even " extremely rare " anomaly  . "
[Show abstract][Hide abstract] ABSTRACT: An anomalous right coronary artery (RCA) with a high anterior take-off from ascending aorta is an uncommon and technically challenging vessel to cannulate. There are only a few reports in the literature describing this anomaly. Some of them consider it as a “very rare” or even “extremely rare” anomaly. Here we present a case of anomalous RCA arising from antero-left part of the ascending aorta, 3 cm above sinotubular junction. It was impossible to cannulate the anomalous vessel from the femoral approach by two experienced operators, despite using various catheters. The vessel could easily be engaged from the right radial approach at first attempt. We conclude that in patients with anomalous high RCA take-off from anterior or especially left-anterior part of the ascending aorta, we suggest to switch to the right radial approach and not to lose much time on the femoral one.
Journal of Cardiology Cases 05/2013; 7(5):e126–e128. DOI:10.1016/j.jccase.2012.12.005
[Show abstract][Hide abstract] ABSTRACT: Angled angiographic views demonstrated two areas of significant systolic narrowing in an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of Valsalva: (1) an ostial stenosis due to kinking as the anomalous artery turned sharply to the right after its origin from the aorta; (2) compression of the proximal segment as it coursed between the aorta and pulmonary artery. Appropriate angiographic studies to evaluate the presence of these changes may help to elucidate their significance.
Catheterization and Cardiovascular Diagnosis 01/1992; 25(1):46 - 51. DOI:10.1002/ccd.1810250110
[Show abstract][Hide abstract] ABSTRACT: The authors describe a case of angioplasty in an anomalous right coronary artery arising from an aberrant ostium in the left sinus of Valsalva anterior and slightly superior to the ostium of the left main coronary artery. The patient also had associated bicuspid aortic valve. To the best of their knowledge, this is the first case of angioplasty in an aberrant right coronary artery originating from an ectopic ostium. The choice of guiding catheter and balloon angioplasty catheter is discussed.
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