| Autor: |
Lolakos, Konstantinos, Butnar, Anda-Cristina, Grosomanidis, Vasilios, Tsotsolis, Nikolaos, Zaglavara, Theodora, Kelpis, Timotheos, Marvaki, Apostolia, Ntontos, Georgios, Nikoloudakis, Nikolaos, Themistokleous, Vasilios, Keremidis, Isaak, Pitsis, Antonios |
| Zdroj: |
Journal of Cardiothoracic & Vascular Anesthesia; Dec2024:Supplement, Vol. 38 Issue 12, p73-73, 1p |
| Abstrakt: |
Anomalous aortic origin of a coronary artery is the congenital heart defect that consists of an abnormal origin and course of a coronary artery. The most common variation is the anomalous origin from the opposite Sinus of Valsalva (SoV), and it can refer either to the left main, the circumflex or the right coronary artery (RCA). In the last case, RCA has an acute angle take-off and an interarterial course between the aorta and the pulmonary artery, which can lead to myocardial infarction, arrhythmia, or sudden cardiac death because of the compromised coronary blood flow. The unroofing procedure includes the excision of the shared wall between the coronary artery and the aorta, eliminating the malignant course, and the creation of a widened neo-ostium. In the current case report, we present two patients with anomalous origin of the RCA from the left SoV, where unroofing was performed and the immediate improvement in coronary blood flow was able to be shown intraoperatively with the usage of transesophageal echocardiography (TOE). A 50yr and a 65yr old male patients were admitted to our hospital with chest pain on exertion and syncopal attacks respectively. After a CT and a classic angiography, they were both proved to have anomalous origin of the RCA from the left SoV with a simultaneous interarterial course between the aorta and the pulmonary artery, which was the cause of their provocative ischemia. Both of them were scheduled for a surgical repair with the unroofing procedure. Intraoperatively and before the repair, we were able to illustrate with TOE both the anomalous origin and the route of the RCA and the reduced coronary flow with the colour Doppler. Following the administration of cardioplegia and a partial aortotomy, the left and right coronary ostia were identified and probed. The RCA ostium was slit-like and positioned in the left SoV. Unroofing was performed by transecting the endothelium from the current ostium along and to the extent of the intramural course of the artery, creating a wider neo-ostium in the correct SoV. Finally, the neo-ostium was marsupialized with interrupted sutures to prevent local dissection. Following the release of the cross clamp, as soon as the coronary blood flow was restored and the heart was normally beating, the surgical result was reassessed with TOE. The unroofing procedure increased the coronary blood flow of the RCA in both patients; this depended both on the the widened neo-ostium on the 2D images and the enriched coloured flow inside the RCA on the colour Doppler images. Also, we were able to depict the neo-ostium with 3D imaging. In this way, there was no need for a postoperative CT angiographic examination. In conclusion, the current case report underlines that anomalies regarding the origin and the route of the coronary arteries are able to be recognised with intraoperative TOE. Furthermore, the coronary ostia and the coronary flow are able to be evaluated with TOE and should always be assessed intraoperatively whenever surgical interventions are being performed on them. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Supplemental Index |
| Externí odkaz: |
|
Full Text from ScienceDirect