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DOI: 10.1055/s-0042-1750412
Intraoperative Finding of Anomalous Circumflex Artery Origin in the Dissected Right Coronary Ostium
Abstract
Anomalous origin of the left circumflex artery is a rare anatomical variant that may present a unique challenge in emergent aortic surgery.
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We present the intraoperative finding of an anomalous origin of left circumflex artery (LCx) in an 85-year-old male who presented with acute Type A aortic dissection, complicated by multiorgan malperfusion and ruptured aortic root with avulsed right coronary ostium. No prior left heart catheterization studies were available at the time of the hospital admission, so the coronary anatomy was unknown. Additionally, the patient presented in extremis and did not have a contrasted computed tomography scan, so the coronary anatomy was not visualized clearly. The aortic dissection involved the left coronary ostium, which was repaired with sutures and was salvaged as a coronary button. While dissecting the right coronary artery (RCA), it was noted that the LCx had an anomalous origin from the RCA. Therefore, the LCx was deliberately transected off the RCA and a coronary artery bypass graft was performed with saphenous vein graft ([Fig. 1]). We felt that direct ostial implantation would have produced too much tension to the LCx attachment; a short “Cabrol”-type graft was considered, but given the small caliber of the LCx, we felt a coronary artery bypass graft was a more reliable revascularization approach. Accordingly, a short saphenous vein graft was anastomosed to the proximal LCx, which laid naturally over the anterior neoaorta. The operation was completed with hemiarch replacement under deep hypothermic circulatory arrest, Bentall root replacement with left coronary button reimplantation, and ascending aortic replacement. The postoperative course was uneventful, and the patient remained symptom-free at 12-month follow-up.
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Anomalous origin of the LCx occurs in 0.3% of the population[1] and may present a unique challenge in emergent cardiac surgery. The potential for anomalous coronary origin warrants careful dissection of the aortic root in patients presenting with Type A aortic dissection when the coronary anatomy is unknown. Additionally, careful anatomic evaluation and detailed surgical planning are of extreme importance also in elective operations involving the aortic root when coronary anomalies are suspected.
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Conflict of Interest
The authors declare no conflict of interest related to this article.
Acknowledgments
None.
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Reference
- 1 Mohsen GA, Mohsin KG, Forsberg M, Miller E, Taniuchi M, Klein AJ. Anomalous left circumflex artery from the right coronary cusp: a benign variant?. J Invasive Cardiol 2013; 25 (06) 284-287
Address for correspondence
Publication History
Received: 12 May 2021
Accepted: 13 April 2022
Article published online:
20 December 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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Reference
- 1 Mohsen GA, Mohsin KG, Forsberg M, Miller E, Taniuchi M, Klein AJ. Anomalous left circumflex artery from the right coronary cusp: a benign variant?. J Invasive Cardiol 2013; 25 (06) 284-287
![](https://www.thieme-connect.de/media/10.1055-s-00039245/202205/thumbnails/10-1055-s-0042-1750412-i210025-1.jpg)
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