Key result
Intraoperative TTFM guides successful proximal RCA ligation for anomalous RCA bypass without 1-year ischemic events.
Why the study?
Surgical treatment for symptomatic anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) is complex and may benefit from intraoperative guidance.
Case Report (n=1)
No
Intraoperative transit time flowmetry can effectively guide proximal ligation during bypass grafting for anomalous origin of the right coronary artery to prevent competitive flow.
May inform ligation decisions in rare anomalous RCA bypass; leaves open generalizability pending prospective data.
Anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) in symptomatic patients is a rare but serious finding whose treatment consists of a surgical correction. The surgical treatment has a level of complexity that could vary from unroofing and ostioplasty to coronary artery bypass grafting. We present our management of a 59-year-old woman presenting with chest pain and dyspnea for right ACAOS with an interarterial route. The right coronary artery (RCA) was bypassed with the right internal thoracic artery. An intraoperative transit time flowmetry (TTFM) showed a competitive flow from the native RCA. RCA proximal ligation site was identified intraoperatively, considering the best mean graft flow (MGF) and the absence of ischemic events. The patient was discharged after a week without adverse events. The 1-year follow-up was uneventful. The intraoperative use of TTFM could guide the surgeon's hand making straightforward the surgical treatment for ACAOS.
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Jiritano et al. (2022) conducted a case report in Anomalous origin of the right coronary artery (ACAOS) (n=1). Transit time flow measurement (TTFM) guided coronary artery bypass grafting was evaluated on Graft flow and absence of ischemic events. Intraoperative use of transit time flow measurement successfully guided the proximal ligation of the right coronary artery during bypass grafting for an anomalous right coronary artery, resulting in excellent graft flow and no ischemic events at 1-year follow-up.
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