Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA.
J Card Surg. 2022 Aug;37(8):2432-2436. doi: 10.1111/jocs.16592. Epub 2022 May 10.
Anomalous right coronary artery (RCA) origin off the ascending aorta, above the level of the sinus of Valsalva, is rare and can be associated with altered hemodynamics, decreased coronary perfusion, and presents unique considerations during intraoperative management in the surgical treatment of concomitant ascending aneurysmal disease.
A 58-year-old female with prior symptomatic visceral aneurysmal rupture and cerebrovascular disease presented with a 5 cm ascending aortic aneurysm, elevated aortic index, and increased rupture risk factors. She was preoperatively diagnosed with an anomalous, high RCA origin off the ascending aorta 15 mm above the sinotubular junction. She underwent successful ascending aortic repair using a 28 mm Dacron hemiarch graft with reimplantation of an RCA button.
Our successful reconstructive surgical repair using an RCA button is effective management for high anomalous RCA take-offs from the ascending aorta and presents the first documented case of this rare coronary anomaly in the context of ascending aortic aneurysmal disease.
发自升主动脉窦上水平之上的异常右冠状动脉（RCA）起源非常罕见，可能与血液动力学改变、冠状动脉灌注减少有关，在手术治疗同时伴发的升主动脉瘤时，其术中管理具有独特的考虑因素。
一名 58 岁女性，既往有症状性内脏动脉瘤破裂和脑血管疾病病史，现患有 5cm 的升主动脉瘤、主动脉指数升高和增加的破裂风险因素。术前诊断为 RCA 发自升主动脉，位于窦管交界上方 15mm，起源异常且位置较高。她成功接受了升主动脉修复术，使用 28mm 的涤纶半弓替换了升主动脉，同时对 RCA 进行了纽扣式再植入。
我们使用 RCA 纽扣成功进行的重建性手术修复对于源自升主动脉的高位 RCA 异常起源是有效的治疗方法，这也是首例在升主动脉瘤疾病背景下发生这种罕见冠状动脉异常的病例。
