Sameh Said Translocation of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) in an Infant.mov (585.25 MB)

Translocation of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery in an Infant

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posted on 24.08.2020, 21:32 by Sameh Said, Gustavo Orellana

The authors present the surgical repair of an anomalous right coronary artery origin from the pulmonary artery (ARCAPA) in an infant. This is a 3-month-old, 4.2 kg boy who was born prematurely at 28 weeks gestation with a birth weight of 750 grams.

The child presented with shortness of breath and sweating during feeding. A soft continuous murmur was heard over the precordium. Echocardiography revealed dilated coronary arteries with multiple intracoronary collaterals with the known “Christmas tree” pattern. The anomalous coronary artery was visualized with its origin from the main pulmonary artery above the pulmonary valve leaflets. Cardiac catheterization confirmed the anomalous origin and the course of the right coronary artery.

Through a standard median sternotomy and after aortic and right atrial cannulation, cardiopulmonary bypass was initiated after both branch pulmonary arteries were snared to prevent steal from the systemic circulation and left ventricular distension secondary to the large left-to-right shunt. Aortic cross clamp was applied and cardioplegia was administered simultaneously in both the aortic and pulmonary roots. The right coronary artery was harvested in a large button from the pulmonary root and translocated to the ascending aorta. The pulmonary site was reconstructed using an appropriately sized bovine pericardial patch.

The postoperative course was uneventful and the patient was extubated in the operating room and was dismissed on the seventh postoperative day on Aspirin. Follow-up echocardiography showed no evidence of shunts with widely patent right coronary neo-ostium with normal antegrade flow. Ventricular function remained normal and CTA confirmed the patency of the coronary artery. He continued to do well at his last follow-up.

References

1. Guenther TM, Sherazee EA, Wisneski AD, Gustafson JD, Wozniak CJ, Raff G. Anomalous origin of the right coronary artery from the pulmonary artery: a systematic review. Ann Thorac Surg. 2020;110(3):1063-1071.

2. Fan H, Jiakan W, Qicai H, Ximing Q, Huaidong C. Images of anomalous origin of the right coronary artery from the pulmonary artery. Heart Surg Forum. 2019 Jul 26;22(4):E308-E309.

3. Ganta S, Vanderploeg M, Kavarana M. Repair of anomalous right coronary artery from the pulmonary artery using the modified trapdoor technique. World J Pediatr Congenit Heart Surg. 2019 Mar;10(2):192-196.

4. Zhang Y, Wang Z, Fang M, Jin Y, Liu Y, Han J, et al. Aortic implantation for anomalous connection of the coronary artery to the pulmonary artery in older children and adults. Thorac Cardiovasc Surg. 2017 Jan;65(1):18-25.

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