Anomalous course of the right coronary artery in the right atrial wall: a word of caution.

作者: Walid C. Dihmis , Michael Shackcloth , Anjum Jalal

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摘要: We report a case of anomalous course the right cornary artery in wall atrium which was encountered dur- ing bypass surgery. As stenotic lesion vessel proximal, large posterior descending branch coronary grafted. Such an has not been previously described literature and lack knowledge such abnormal may result inadvertant damage during cannulation inferior vena cava or sinus. INTRODUCTION The normally lies subepicar- dial plane ventricle. documented variations this position include intra-mural , intracavity so called aerial when it above ventricular surface. operated upon patient whom lying atrial about one half centimeter away from atrioventricular groove. To our . clin- ical operative summary provide over- view anomalies artery. CASE REPORT A 58 years old male with chronic stable angina admitted for elective coro- nary angiogram demostrated 95 % stenosis proximal (RCA), left antrior (LAD), 99 diagonal LAD 90 circumflex did suggest any abnormality vessel. operation performed using standard cardiopulmonary aortic two stage venous cannula. Dissection first carried out However, seen. thorough examination area showed that (see Figures 1 2, ) atrio-ventricular groove confirmed by advancing probe retrograde through arteriotomy located proximally RCA, we grafted its branch. rest procedure uneventful post-operative recovery satisfactory. DISCUSSION Isolated congenital arteries are found 0.3-1.3% patients undergoing angiogra- phy (Kimbris 1978). These involve origin and/or five frequently anomlies : i) pulmonary artery, ii) arising inappropriate sinus, iii) iv) sinus v) septal (Nugent 1990). Most these remain unnoticed except those produce severe ischemia. Various descriptions can be literature. Although is diffi- cult to classify all anomalies, there few classifica- tions attempt cover both anatomic nature their clinical behaviour (Roberts 1986, Jalal 1998).

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