The best approach to repair anomalous origin of the right coronary artery.

Anomalous origin of the right coronary artery: right internal thoracic artery of the right coronary artery bypass is not the answer. Minimally invasive direct coronary artery bypass – a surgical approach for anomalous right coronary artery from left aortic sinus of Valsalva. Anomalous right or left coronary artery from the contralateral coronary sinus: " high-risk " abnormalities in the initial coronary artery course and heterogeneous clinical outcomes.tion utilizing cardiopulmonary bypass for coronary unroofing of anomalous coronary artery. Direct coronary reimplan-tation for anomalous origin of the right coronary from the left sinus of Valsalva. I read with interest the manuscript on the technique of minimally invasive approach to perform a right internal mammary artery-right coronary Artery bypass in patients with anomalous origin of the right coronary artery [1]. This technique is ingenuous and certainly unique. However, I don't believe this is the right approach for patients with this disorder. The issue with these patients is that the anomalous coronary comes off the left coronary cusp usually above the true left main coronary. This usually is a slit-like orifice and then the artery itself comes between the aorta and the pulmonary artery. This anatomy often leads to sudden death. The issue here is during exercise it is thought that the coronary artery can be compressed by the pulmonary artery and cause myo-cardial ischaemia. Techniques of bypass certainly can be done simply. Unfortunately, the native flow of this vessel is totally normal. As a result, the internal mammary artery tends to become atretic since its flow is not needed except in rare circumstances. We have had this experience in a group of patients that we have reported previously [2]. We had two situations where internal mammary arterial bypasses had been performed and unfortunately both became atretic. They still required the standard operation which is unroofing in one case and transposition in the other to solve the situation. Subsequent to that publication, we have had two other similar circumstances. Therefore, we would conclude that internal mammary arterial bypass is not the appropriate approach for this disorder. Anomalous origin of the right coronary artery: right internal thoracic artery to right coronary artery bypass is not the answer.