Abstract
We appreciate the comments from professor Probal K. Ghosh concerning amomalous origin of right coronary artery (ARCA), supporting our conclusion that myocardial revascularization is advisable in symptomatic patients with ARCA even though ischemia cannot be detected by exercise testing or myocardial scintigraphy [ 11. The technetium scintigraphy (99m Tc-sestamibi) used in our case report may be more accurate than a thallium scintigraphy in detecting myocardial perfusion abnormalities [2,3]. Limitations of both techniques particularly in detecting ischemia at the infero-basal portion of the myocardium have been demonstrated [4]. Due to a higher spatial resolution, a PET (dipyridamole) perfusion scanning may have improved the diagnostic accuracy for detection of myocardial perfusion defects. However, uncertainty of the dynamic characteristics of ARCA (compression or kinking of the artery, closure of a slit-like orifice, vasospasm) may be the critical factor that makes the decision of surgical correction to rely only on the patient’s symptoms and the angiographic findings.
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