Modified Reconstruction of Coronary Arteries in Total Aortic Root Replacement in a Patient with Intramural Right Coronary Artery of Anomalous Origin.
10.4326/jjcvs.25.67
- VernacularTitle:右冠動脈左バルサルバ洞起始および大動脈壁内走行を示す症例に対する大動脈基部全置換術 冠動脈再建術式における一工夫
- Author:
Toru Yasutsune
;
Kanzi Matsui
;
Naho Haraguchi
;
Toshiaki Kurakazu
;
Kouji Matsuzaki
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
1996;25(1):67-70
- CountryJapan
- Language:Japanese
-
Abstract:
Total replacement of the aortic root in patients with anomalous origin of the coronary arteries has not been reported. We report a 63-year-old male with anomalous origin of the right coronary artery from the left sinus of Valsalva in whom aortic root replacement was performed to correct a 60mm aortic root aneurysm and a grade 4/4 aortic regurgitation. In this operation with a composite graft (a 24mm Gelseal graft with a 23mm St. Jude Medical prosthesis), modified reconstruction of the coronary arteries was necessary not only because both coronary ostia were in close proximity but also because the proximal portion of the right coronary artery was intramural. We used a modification of Piehler's technique in which both coronary ostia were simultaneously anastomosed to a beveled 10mm Gelseal graft. In this anastomosis, a small piece of the autologous pericardium was interposed between the graft and the aortic wall surrounding the ostium of the right coronary artery to protect the intramural artery from injury. This modification in reconstructing the coronary arteries was technically easy and effective in the special setting of the anomalous origin of the coronary arteries.
