Anomalous origin of the left main coronary artery. Surgical management

Abstract

A 53-year-old man, with no medical history, presented with acute coronary syndrome. Coronary angiography revealed a common right ostium giving rise to both the right coronary artery and the left main coronary artery. The left interior mammary artery was used as a single bypass graft to the left anterior descending coronary artery. The patient was asymptomatic on follow-up.

Abnormal origins of the coronary arteries from the aortic root

“…Direct implantation may be performed for group a, especially if the orifices are well separated. [93][94][95][96][97] It is usually unsuitable for the other anatomic types because of insufficient tissue to create a button around the orifice or the need to avoid kinking. However, it is not clear that this anatomy causes proximal obstruction.…”

“…Single ostium or single coronary artery. Sometimes the coronary artery with an anomalous origin shares a single orifice with the normal artery or common trunk and does not have an intramural course in the aortic wall (type c), 97 or else there is a single coronary artery that bifurcates outside the aorta (type d).…”

“…Sometimes the coronary artery with an anomalous origin shares a single orifice with the normal artery or common trunk and does not have an intramural course in the aortic wall (type c), 97 or else there is a single coronary artery that bifurcates outside the aorta (type d). Removing and reimplanting the ectopic artery into its appropriate sinus of Valsalva may be difficult because there may not be enough tissue to provide a large button for implantation 98 …”