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Ann Thorac Surg 2002;74:973-974
© 2002 The Society of Thoracic Surgeons

Correspondence

Right coronary arteries that course between aorta and pulmonary artery

Raul García-Rinaldi, MD, PhDa

a Cardiovascular Surgery Program, Advanced Cardiology Center, Centro Medico Ramon Emeterio Betances, PO Box 1838, Mayaguzz, PR 00681 USA

e-mail: garciarinald{at}prtc.net

To the Editor

I was very surprised to read the article on pulmonary artery translocation by Rodefeld and associates [1]. Right coronary arteries that arise from the left sinus, of which four variants exist [2], have a slit orifice and an intramural segment [3]. The anomalous right coronary artery has a common wall with the aorta. In cases where the anomalous trunk passes under the left-right commissure, additional compression is applied by the aortic valve [3].

In 1994, my colleagues and I [3] reported our experience with the surgical treatment of coronary arteries with anomalous origin and slit ostium. Right coronary arteries that arise ectopically from the right sinus also have a slit ostium and an intramural segment [4, 5]. These right coronary arteries physiologically behave like those that arise in an anomalous manner [3]. The rationale for surgical therapy is to convert the slit orifice into an opening of 4 to 5 mm that alleviates compression of the trunk in the intramural segment.

We recently reviewed our data and, to date, have operated on 19 patients without any operative deaths. The mean follow-up is 6.2 years (range, 0.3 year to 12.3 years), and the 18 surviving patients are in New York Heart Association class I or II.

Creating a new orifice for the takeoff of the right coronary artery is a very simple procedure and is certainly easier than performing a pulmonary artery translocation. I encourage Rodefeld and colleagues to try this simple approach to a complex clinical problem.

References

  1. Rodefeld M.D., Culbertson C.B., Rosenfeld H.M., Hanley F.L., Thompson L.D. Pulmonary artery translocation: a surgical option for complex anomalous coronary artery anatomy. Ann Thorac Surg 2001;72:2150-2152.[Abstract/Free Full Text]
  2. Kragel A.H., Roberts W.C. Anomalous origin of either the right or left main coronary artery from the aorta with subsequent coursing between aorta and pulmonary trunk: analysis of 32 necropsy cases. Am J Cardiol 1988;62:771-777.[Medline]
  3. Garcia Rinaldi R., Carballido J., Giles R., Del Toro E., Porro R. Right coronary artery with anomalous origin and slit ostium. Ann Thorac Surg 1994;58:828-832.
  4. Virmani R., Chun P.K.C., Goldstein R.E., et al. Acute take-offs of the coronary arteries along the aortic wall and congenital ostial valve ridges: a case of sudden death [Abstract]. Circulation 1982;66(Suppl 2):104.
  5. Virmani R., Chun P.K.C., Goldstein R.E., et al. Acute take-offs of the coronary arteries along the aortic wall and congenital coronary ridges: association with sudden death. J Am Coll Cardiol 1984;3:766-771.[Abstract]



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