Case report
A 66-year-old hypertensive female patient was investigated for attacks
of unstable angina. Her cardiac examination was unremarkable, and her
electrocardiogram showed signs of left ventricular strain pattern. An
Echocardiogram demonstrated regional wall abnormalities in the anterior
and the inferior segments of the heart. Left heart catheterization
demonstrated significant right coronary artery stenosis, with super
dominance in distribution pattern. The left main coronary artery had
anomalous origin from the opposite right coronary cusp with separate
ostium with significant luminal stenosis and small caliber left anterior
descending (LAD) and Circumflex arteries. Coronary Computed Tomography
(CT) for better assessment of the left main coronary anatomy was
performed and showed an anomalous left main coronary artery arising from
the opposite sinus and courses posterior to the aortic root with
significant stenosis (Figure 1). The course also showed an interarterial
passage between the pulmonary artery and the aorta with small and
diseased branches (Figure 2). A heart team decision was made to offer
this lady coronary artery bypass surgery as a valued option taking in
consideration her left main coronary anomaly in addition to the
atherosclerotic disease involving her coronary arteries.
Surgery was performed via median sternotomy incision using partial
cardiopulmonary bypass utilizing left internal mammary artery (LIMA) and
left great saphenous vein as conduits. myocardial protection was
achieved using ante and retrograde routs of delivery for cardioplegic
solutions. Vein grafts were used to bypass diseased RCA and the
circumflex arteries while the LIMA was anastomosed to the left anterior
descending artery. Intraoperative assessment of the grafts was performed
using flowmeter and all the grafts showed excellent flow parameters.
Patient did well and had uneventful recovery period and was dismissed
from the hospital in fair condition.