Thrombosis in the Surgically Corrected Anomalous Right Coronary Artery after Reimplantation in Aorta

Bajwa, Ata; Gupta, Bhanu; Ya’qoub, Lina; Laster, Steven B.; Thompson, Randall C.

doi:10.1155/2017/5832692

Cited by 4 publications

(4 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The anomalous RCA can be either re-implanted to the aorta or ligated [ 14 ]. However, long-term outcomes of such procedures were not well studied in the majority of cases, with a few patients reported to develop thrombosis in the implanted artery after surgical repair [ 2 , 14 , 15 ]. Conservative medical management has also been described for this anomaly, especially when risk of surgery was deemed to outweigh benefits [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Morbidly Obese Patient Presenting with Chest Pain

2018

View full text Add to dashboard Cite

Patient: Female, 58Final Diagnosis: Anomalous origin of RCA from PA with reversible myocardial ischemia of the inferior wallSymptoms: Chest pain • shortness of breathMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Congenital defects/diseasesBackground:Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital anomaly with an incidence of 0.002%.Case Report:A 58-year-old African American female with a history of diabetes mellitus, hyperlipidemia, and hypertension was evaluated for shortness of breath and chest heaviness. On physical examination, she was found to be morbidly obese. Her blood pressure was 160/90 mmHg. There were no carotid bruits or jugular venous distension. Cardiac auscultation showed distant heart sounds with no audible murmurs. Lower extremity examination showed +1 edema with weak pedal pulses. ECG showed non-specific ST segment and T-wave changes. Echocardiogram demonstrated dysfunction grade I with preserved ejection fraction. An adenosine nuclear study showed an area of reversible ischemia of the inferior wall. Selective left coronary angiography showed the left coronary artery (LCA) originating from the left sinus of Valsalva. From the LCA, the left anterior descending and the left circumflex coronary arteries arose in a typical course. The right coronary artery (RCA) was visualized in a retrograde fashion via collaterals originating from the left coronary system and it drained into the pulmonary artery. On aortic root angiography, the origin of the RCA could not be determined. The patient’s surgical risk was deemed unacceptably high and she was not considered a surgical candidate. Her symptoms were controlled conservatively.Conclusions:By reporting this case, we shed some light on a rare congenital anomaly involving the coronary arteries. Variable presentations have been described for ARCAPA, however, many patients remain asymptomatic. Diagnosis can be confirmed by coronary angiography. Surgical correction is the definitive treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Morbidly Obese Patient Presenting with Chest Pain

2018

View full text Add to dashboard Cite

show abstract

“…Brooks described the first case of ARCAPA in 1885 [2]. ARCAPA is potentially life threatening due to its consequential conditions such as coronary ischemia, heart failure, and sudden cardiac death (in infancy/adolescence/adulthood due to fatal arrhythmia) [3]. This defect is also known to pose as a challenge during surgical procedures, usually because it is incidentally diagnosed in the operation room [4].…”

Section: Introductionmentioning

confidence: 99%

“…Many different imaging modalities are available to diagnose ARCAPA. These include echocardiography, magnetic resonance angiogram (MRA), and multislice-gated coronary CT angiogram, with the latter two being more reliable [3]. The detection of ARCAPA is usually incidental while patient is undergoing evaluation for other problems, for example, a coronary angiography being done for chest pain [7].…”

Section: Introductionmentioning

confidence: 99%

Anomalous Origin of a Right Coronary Artery from Pulmonary Artery

Rawala

Naqvi

Farhan

et al. 2018

Case Reports in Cardiology

View full text Add to dashboard Cite

Congenital defects of the coronary arteries are noted in 0.2–1.4% of the general population. The first case of an anomalous origin of right coronary artery from pulmonary artery (ARCAPA) was described by Brooks in 1885. ARCAPA has an overall incidence of 0.002% in the general population. Most of the cases are asymptomatic; however, it can lead to serious complications such as heart failure, ischemia, and sudden death. A 57-year-old man presented to the cardiologist's office with complaints of shortness of breath and fatigue. The patient also had a previous history of coronary stents and heart failure. Initially, he was evaluated with a stress test which was reported as abnormal. The patient then underwent an invasive coronary angiography that revealed anomalous origin of the right coronary artery (RCA) and multivessel disease. Cardiothoracic surgery evaluated the patient and coronary artery bypass graft was performed. During the surgery, the anomalous origin of RCA from the pulmonary artery was identified and was successfully corrected by reimplanting the RCA into the ascending aorta. The anomalous origin of RCA is a rare yet life-threatening condition. The RCA due to its location of origin from the pulmonary artery tends to be a low-pressure vessel with a very thin and fragile wall. It also serves as a retrograde venous conduit from the left coronary circulation into the pulmonary artery. This connection results in a left-to-right shunt that explains the increase in oxygen saturation in the pulmonary artery and the high cardiac output which is normally seen in these cases. The clinical presentation can vary from coronary ischemia to heart failure or sudden death. Therefore, surgical correction is recommended even in asymptomatic patients. We present a case of an anomalous origin of RCA from the pulmonary artery which, unlike the origin of left coronary from pulmonary artery, is very rare. Patients with this condition should have early correction even if they are asymptomatic in order to prevent long-term complications.

show abstract

“…Historically, some patients received right coronary artery ligation, but this is sub-optimal and avoided whenever possible. 6 , 7 Due to the rarity of the condition, outcomes after surgical ARCAPA repair are limited to isolated case reports or case series with limited follow-up. 5 , 8 , 9 Here, we report the in-hospital and long-term outcomes of patients after surgical repair for ARCAPA who are enrolled in the Pediatric Cardiac Care Consortium (PCCC), a large US-based registry of interventions for CHDs.…”

mentioning

confidence: 99%

Long-term outcomes after repair for anomalous right coronary artery from the pulmonary artery

et al. 2022

View full text Add to dashboard Cite

Anomalous right coronary artery from pulmonary artery (ARCAPA) is a rare congenital heart disease that can lead to abnormal coronary perfusion and a need for surgical repair. Here, we report the outcomes of patients who underwent ARCAPA surgery within the Pediatric Cardiac Care Consortium (PCCC), a North American registry of interventions for paediatric heart diseases. We queried the PCCC for patients undergoing surgical repair for ARCAPA at <18 years of age between 1982 and 2003. Outcomes were obtained from the PCCC and after linkage with the National Death Index (NDI) and the Organ Procurement and Transplantation Network (OPTN) through 2019. Twenty-four patients (males: 15) were identified having surgery for ARCAPA at a median age of 5.8 (IQR 2.7–10.3) years. Of them, 23 cases were considered “simple” (without major intracardiac disease) and one “complex” (co-existing with tetralogy of Fallot). Five patients presented with symptoms [chest pain (1), dyspnoea on exertion (2) or history of syncope (2)]; while the remaining 19 patients were referred for evaluation of either murmur or co-existing CHD. There was no in-hospital mortality after the surgical repair. Fourteen patients had sufficient identifiers for NDI/OPTN linkage; among them, only one death occurred from unrelated non-cardiac causes within a median period of 19.4 years of follow-up (IQR: 18–24.6). Outcomes were excellent after reimplantation up to 25 years later and further longitudinal monitoring is important to understand the interaction of pre-existing coronary pathology with the effects of ageing.

show abstract

Thrombosis in the Surgically Corrected Anomalous Right Coronary Artery after Reimplantation in Aorta

Cited by 4 publications

References 20 publications

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Morbidly Obese Patient Presenting with Chest Pain

Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in a Morbidly Obese Patient Presenting with Chest Pain

Anomalous Origin of a Right Coronary Artery from Pulmonary Artery

Long-term outcomes after repair for anomalous right coronary artery from the pulmonary artery

Contact Info

Product

Resources

About