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J Thorac Cardiovasc Surg 2007;133:456-460
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Anomalous origin of the right coronary artery: Right internal thoracic artery to right coronary artery bypass is not the answer

Lynn M. Fedoruk, MD*, John A. Kern, MD, Benjamin B. Peeler, MD, Irving L. Kron, MD

University of Virginia, Division of Thoracic and Cardiovascular Surgery, Charlottesville, Va

Received for publication August 4, 2006; revisions received October 3, 2006; accepted for publication October 9, 2006.

* Address for reprints: Lynn Fedoruk, MD, Division of Thoracic and Cardiovascular Surgery, University of Virginia Heart Center, PO Box 800679, Charlottesville, Va (Email: lf4n{at}telus.net).

OBJECTIVE: Anomalous origin of the right coronary artery from the opposite sinus of Valsalva can be a lethal congenital anomaly. Right internal thoracic artery grafting to the right coronary artery is prone to fail in this circumstance. We sought to describe alternative surgical techniques.

METHODS: Retrospective analysis identified 5 adult and pediatric patients in our database. We reviewed the surgical techniques used to repair this anomaly. On the basis of our experience, we describe our management technique.

RESULTS: There were no operative deaths, and postoperative computed tomographic scans demonstrated widely patent repairs in all patients. Two patients with previous right internal thoracic artery to right coronary artery grafts presented with occlusion of the right internal thoracic artery. Short-term follow-up demonstrated continued patency.

CONCLUSION: Right internal thoracic artery grafting fails in this circumstance, and alternative surgical options provide a good outcome.

Abbreviations and Acronyms CABG = coronary artery bypass grafting; CPB = cardiopulmonary bypass; CT = computed tomography; ITA = internal thoracic artery; RCA = right coronary artery; RITA = right internal thoracic artery




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