Successful off-pump reimplantation of the anomalous right coronary artery from the pulmonary artery: A case report

Abstract

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare occurrence that requires surgical repair, typically via cardiopulmonary bypass (CPB). In this study, we present the case of a patient with ARCAPA with a high risk of cerebral infarction and left main trunk stenosis. However, because of the high risk of cerebral infarction, CPB was no longer an option during surgical intervention. Instead, we performed off-pump reimplantation of the ARCAPA to the ascending aorta and coronary artery bypass grafting of the left coronary artery. The patient had an uneventful postoperative course. Based on the successful outcomes of this case, we suggest off-pump reimplantation of the ARCAPA to the ascending aorta as a useful alternative for patients who are not eligible to undergo CPB during surgical repair. <Learning objective Although surgical repair of the anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) usually requires cardiopulmonary bypass (CPB), we present a successful off-pump reimplantation for those who are not eligible to undergo CPB. We performed off-pump reimplantation of the ARCAPA to the ascending aorta and coronary artery bypass grafting of the left coronary artery. Therefore, we found off-pump reimplantation of the ARCAPA to the ascending aorta to be a useful alternative to CPB in high-risk patients.>.

Keywords: Anomalous right coronary artery; Pulmonary artery; Reimplantation.

Fig. 1

Preoperative coronary computed tomographic reconstruction shows the ARCAPA arising from the main pulmonary artery (A). (B) Preoperative coronary angiography. (C) Postoperative coronary computed tomographic reconstruction. Ao, ascending aorta; ARCAPA, anomalous origin of the right coronary artery from the pulmonary artery; PA, pulmonary artery; RCA, right coronary artery; LCA, left coronary artery.

Fig. 2

Operative photograph showing reimplantation of the ARCAPA into the aorta. White arrows show the ARCAPA. (A) The ARCAPA arising from the main pulmonary artery. (B) The purse-string for ARCAPA. (C) Anastomosis of ARCAPA to Ascending Aorta using Enclose II®. (D) The reimplanted ARCAPA into the aorta. Ao, ascending aorta; ARCAPA, anomalous origin of the right coronary artery from the pulmonary artery; PA, pulmonary artery; RCA, right coronary artery.