Katoh Yusuke, Ohki Satoshi, Yamaguchi Ryo, Miki Takao, Nagasawa Ayako, Okonogi Shuichi, Yasuhara Kiyomitsu, Obayashi Tamiyuki
Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, JPN.
Cureus. 2023 Sep 14;15(9):e45205. doi: 10.7759/cureus.45205. eCollection 2023 Sep.
Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital cardiac abnormality. Although AAOCA can cause angina, syncope, palpitations, and sudden cardiac death, most patients remain asymptomatic. A 60-year-old woman experienced occasional chest discomfort. A coronary computed tomography (CT) showed that the right coronary artery (RCA) originated from the left sinus of Valsalva, indicating AAORCA. Exercise myocardial scintigraphy revealed ischemia in the inferior wall. Cardiac catheterization showed stenosis in the ostium of the RCA. Therefore, direct reimplantation of the RCA into the right sinus was performed under cardiopulmonary bypass. The patient recovered uneventfully, postoperatively. Postoperative coronary CT showed no evidence of bending or stenosis in the RCA. Moreover, exercise scintigraphy showed no ischemic changes. The patient was discharged on postoperative day 18 after the resolution of chest discomfort and remained healthy for the following one year. AAORCA is a rare congenital abnormality that could lead to sudden cardiac death. Appropriate imaging studies and surgery should be performed in symptomatic patients with AAORCA who have inter-arterial paths between the ascending aorta and pulmonary artery with right coronary ostial stenosis. Reimplantation of the RCA directly into the right coronary sinus with adequate mobilization of the RCA is a simple procedure that can return the anatomic and biophysiologic status of AAORCA patients to normal and resolve most morphologic abnormalities.
冠状动脉异常起源于主动脉（AAOCA）是一种罕见的先天性心脏异常。虽然AAOCA可导致心绞痛、晕厥、心悸和心源性猝死，但大多数患者无症状。一名60岁女性偶尔感到胸部不适。冠状动脉计算机断层扫描（CT）显示右冠状动脉（RCA）起源于主动脉左窦，提示AAORCA。运动心肌闪烁显像显示下壁缺血。心导管检查显示RCA开口处狭窄。因此，在体外循环下将RCA直接重新植入右窦。患者术后恢复顺利。术后冠状动脉CT显示RCA无弯曲或狭窄迹象。此外，运动闪烁显像显示无缺血改变。患者在胸部不适缓解后于术后第18天出院，随后一年保持健康。AAORCA是一种罕见的先天性异常，可导致心源性猝死。对于有症状的AAORCA患者，若升主动脉与肺动脉之间存在动脉间路径且右冠状动脉开口狭窄，应进行适当的影像学检查和手术。将RCA充分游离后直接重新植入右冠状动脉窦是一种简单的手术方法，可使AAORCA患者的解剖和生物生理状态恢复正常，并解决大多数形态学异常。
