Aortic Valve Replacement and Concomitant Coronary Artery Bypass Grafting in a Patient with Infective Endocarditis and Anomalous Origin of the Right Coronary Artery from the Opposite Sinus of Valsalva

Abstract

A 69-yrs-old woman with anomalous origin of the right coronary artery from the opposite sinus of Valsalva (ACAOS) was diagnosed as having infective endocarditis affecting the aortic valve. Transthoracic echocardiography showed severe aortic stenosis and vegetations on the cusp of the aortic valve, which necessitated aortic valve replacement. Before the operation, computed tomography showed a right-ACAOS, with the artery running an interarterial course between the aorta and pulmonary artery. ACAOS running an interarterial course has been reported to be associated with an increased risk of ischemic cardiac events and sudden death. The patient was treated successfully by the aortic valve replacement with concurrent coronary artery bypass grafting using a saphenous vein graft for the right coronary artery.Keywords: anomalous origin of a coronary artery from the opposite sinus (ACAOS), interarterial course, infective endocarditis, coronary artery bypass grafting IntroductionCongenital coronary arterial anomalies are common, occurring in an estimated 0.3% to 1.3% of the population.1 Although most cases are clinically asymptomatic, some anomalies have been reported to be associated with an increased risk of myocardial ischemia and infarction, congestive heart failure, and/or sudden cardiac death. One of the highest-risk coronary malformations is anomalous origin of both the right and left coronary arteries from the opposite sinus of Valsalva (ACAOS),particularly in cases where the artery runs an interarterial course between the aorta and pulmonary artery.1 Anomalous origin of the left coronary artery from the opposite sinus of Valsalva (left-ACAOS) is an absolute indication for surgical intervention, whereas, the indication for surgery in patients with right-ACAOS still remains controversial. We performed aortic valve replacement and coronary artery bypass grafting in a patient with right-ACAOS presenting infective endocarditis of the aortic valve. Case ReportA 69-yrs-old woman with moderate aortic and mitral valve stenosis was referred to our out-patient clinic 2 yrs ago. She had undergone closed mitral commissurotomy 38 yrs ago and had remained in relatively A 69-yrs-old woman with anomalous origin of the right coronary artery from the opposite sinus of Valsalva (ACAOS) was diagnosed as having infective endocarditis affecting the aortic valve. Transthoracic echocardiography showed severe aortic stenosis and vegetations on the cusp of the aortic valve, which necessitated aortic valve replacement. Before the operation, computed tomography showed a right-ACAOS, with the artery running an interarterial course between the aorta and pulmonary artery. ACAOS running an interarterial course has been reported to be associated with an increased risk of ischemic cardiac events and sudden death. The patient was treated successfully by the aortic valve replacement with concurrent coronary artery bypass grafting using a saphenous vein graft for the right coronary artery.Keywords: anomalous origin of a coronary artery from the oppos...

Aortic Valve Endocarditis with Anomalous Origin of the Right Coronary Artery and Unknown Infected Thrombus in the Dissected Descending Thoracic Aorta

“…In similar cases, anomalous coronary anatomy has been approached with coronary artery bypass grafting (CABG) rather than coronary unroofing. 2 While CABG eliminates the need to anatomically modify the aorta, it can predispose the patient to need for future interventions on the bypass graft. Despite the higher risk for intraoperative complications associated with coronary unroofing, this procedure effectively eliminates the need for future intervention on a bypass graft.…”