Origen anómalo de la arteria coronaria derecha desde el seno de Valsalva izquierdo

Abstract

Anomalous aortic origin of the coronary arteries is uncommon but clinically significant. Because of its low incidence it is not known the actual prevalence of this anomaly. Manifestations vary from asymptomatic patients to those who present with angina pectoris, myocardial infarction, heart failure, syncope, arrhythmias, and sudden death. We describe 9 patients, aged 28 to 72 years, who were diagnosed with right coronary artery arising from the left sinus of Valsalva, confirmed by coronary angiography, which were surgically repaired. Five patients presented dyspnea and angina, two with acute myocardial infarction and the remaining two were studied for atypical chest pain and ventricular premature contractions. At operation, the right coronary artery was dissected at the take-off from the intramural course, and reimplanted into the right sinus of Valsalva. There was no mortality. One patient had associated coronary artery disease that required stent placement postoperatively. This reimplantation technique provides a good physiological and anatomical repair, eliminates a slit-like ostium, avoids compression of the coronary artery between the aorta and the pulmonary artery, and gives superior results to coronary artery bypass grafting or the unroofing technique.