Jiritano Federica, Leone Angelo, Greco Francesco, Leporace Mario, Bova Carlo, Aiello Vincenzo, Serraino Giuseppe Filiberto, Mastroroberto Pasquale
Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University "Magna Græcia" of Catanzaro, Catanzaro, Italy.
Cath Lab Unit, Azienda Ospedaliera Santissima Annunziata Hospital, Cosenza, Italy.
Front Cardiovasc Med. 2022 Oct 20;9:975014. doi: 10.3389/fcvm.2022.975014. eCollection 2022.
Anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) in symptomatic patients is a rare but serious finding whose treatment consists of a surgical correction. The surgical treatment has a level of complexity that could vary from unroofing and ostioplasty to coronary artery bypass grafting. We present our management of a 59-year-old woman presenting with chest pain and dyspnea for right ACAOS with an interarterial route. The right coronary artery (RCA) was bypassed with the right internal thoracic artery. An intraoperative transit time flowmetry (TTFM) showed a competitive flow from the native RCA. RCA proximal ligation site was identified intraoperatively, considering the best mean graft flow (MGF) and the absence of ischemic events. The patient was discharged after a week without adverse events. The 1-year follow-up was uneventful. The intraoperative use of TTFM could guide the surgeon's hand making straightforward the surgical treatment for ACAOS.
有症状患者中冠状动脉起源于对侧瓦尔萨尔瓦窦（ACAOS）是一种罕见但严重的发现，其治疗方法为手术矫正。手术治疗的复杂程度各异，从开窗和造口术到冠状动脉旁路移植术不等。我们介绍了对一名59岁女性的治疗情况，该患者因右冠状动脉起源于对侧瓦尔萨尔瓦窦并走行于动脉间而出现胸痛和呼吸困难。使用右胸廓内动脉对右冠状动脉（RCA）进行了旁路移植。术中经食管超声心动图（TTFM）显示来自自身RCA的竞争性血流。考虑到最佳平均移植血流（MGF）且无缺血事件，术中确定了RCA近端结扎部位。患者术后一周出院，无不良事件。1年随访无异常。术中使用TTFM可指导外科医生操作，使ACAOS的手术治疗更为直接。
