Benjanuwattra Juthipong, Abdelnabi Mahmoud, Leelaviwat Natnicha, Cavazos Annia, Sethi Pooja, Jenkins Leigh Ann
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Cardiology and Angiology Unit, Department of Clinical and Experimental Internal Medicine, Alexandria University, Alexandria, Egypt.
Eur J Case Rep Intern Med. 2022 Dec 16;9(12):003692. doi: 10.12890/2022_003692. eCollection 2022.
Patients with symptomatic or malignant anomalous aortic origin of the right coronary artery (AAORCA) warrant surgical treatment to decrease morbidity and mortality. Various surgical techniques have been implemented including unroofing, reimplantation and bypass grafting. A 43-year-old woman presented with intermittent chest pain due to malignant AAORCA and received saphenous bypass grafting, instead of reimplantation, due to intraoperative spasm.
Various surgical methods are available for the management of anomalous aortic origin of the right coronary artery (AAORCA), preferably unroofing when the intramural segment can be identified.Hypoplasia of the proximal segment, an acute take-off angle, and close proximity to the intercoronary pillar or commissure are limitations to unroofing, and alternative approaches are more appropriate.Coronary artery bypass graft, with either arterial or venous graft, can be performed when unroofing and reimplantation are not feasible. Measuring the distal anastomosis flow may help with a decision regarding native coronary artery ligation. It remains undetermined whether arterial or venous grafts provide superior outcomes.
有症状或恶性的右冠状动脉异常主动脉起源（AAORCA）患者需要进行手术治疗以降低发病率和死亡率。已实施了各种手术技术，包括开窗术、再植入术和旁路移植术。一名43岁女性因恶性AAORCA出现间歇性胸痛，由于术中痉挛，接受了大隐静脉旁路移植术而非再植入术。
对于右冠状动脉异常主动脉起源（AAORCA）的治疗有多种手术方法，当能识别壁内段时，首选开窗术。近端段发育不全、锐角起始以及靠近冠状动脉间支柱或联合处是开窗术的限制因素，采用其他方法更合适。当开窗术和再植入术不可行时，可进行动脉或静脉移植的冠状动脉旁路移植术。测量远端吻合口血流可能有助于决定是否结扎自体冠状动脉。动脉或静脉移植哪种效果更佳仍未确定。
