Chonnam Med J.  2015 Apr;51(1):43-46. 10.4068/cmj.2015.51.1.43.

Totally Occluded Grafted Right Internal Mammary Artery to Anomalously Originated Right Coronary Artery

• Park H
• Hong YJ
• Lee S
• Oh TR
• Choi J
• Kim M
• Park KH
• Sim DS
• Ahn Y
• Jeong MH
• Cho JG
• Park JC

• KMID: 2172147
• DOI: http://doi.org/10.4068/cmj.2015.51.1.43

Abstract

An anomalous aortic origin of a coronary artery is rare and surgical intervention is recommended when the patient is symptomatic. We performed coronary artery bypass graft surgery in a 21-year-old male patient with a right coronary artery anomalously originating from the left coronary sinus. The artery was significantly stenosed by external compression between the aorta and the pulmonary artery. However, the graft became occluded 1 year after the operation. In such cases, the dynamic nature of the stenosis can cause relatively intact antegrade competitive flow from the native coronary artery and lead to an occlusion of the grafted artery. Methods for evaluating flow rates or intraluminal pressures of native arteries could be helpful in decision-making in similar cases.

Keyword

Coronary artery bypass; Coronary disease; Coronary vessel anomalies

MeSH Terms

Aorta
Arteries
Constriction, Pathologic
Coronary Artery Bypass
Coronary Disease
Coronary Sinus
Coronary Vessel Anomalies
Coronary Vessels*
Humans
Male
Mammary Arteries*
Pulmonary Artery
Transplants*
Young Adult

Figure

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  FIG. 1 Cardiac Computed Tomography Angiography. The right coronary artery is originated from the left coronary sinus (blue long arrow) and was trapped between the aorta (red short arrow) and the pulmonary artery (yellow arrowhead).

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  FIG. 2 Coronary angiography showed that both the right coronary artery (blue long arrow) and the left coronary arteries (red short arrows) originated from the left coronary sinus simultaneously, suggesting an anomalously originating RCA (left image). The left coronary arteries are normal (right image).

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  FIG. 3 The right coronary artery seems to be normal in the left anterior oblique view (left image), but in the right anterior oblique view, significant stenosis in the proximal RCA due to external compression is shown (right image, blue arrow).

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  FIG. 4 After coronary artery bypass grafting surgery, a patent right internal mammary artery (red short arrow) to the right coronary artery (blue long arrow) is noted.

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  FIG. 5 One year after coronary artery bypass graft surgery, the right internal mammary artery was totally occluded (blue long arrow), whereas the 3 coronary arteries were unchanged (upper 2 images) and the right subclavian artery was intact (short red arrow).

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