Angiographic interpretation and surgical management of right coronary artery obstructions.
We have found that even high quality arteriography and multiple projections may not clearly delineate the total extent of disease in a severely obstructed right coronary artery. Selection of the anastomotic site is more often based upon the operative findings. Totally obstructed vessels can be more aggressively explored and opened, because failure of adequate graft reconstruction does not result in significant infarction. Once a subtotally obstructed right coronary artery has been opened, the surgeon must achieve a patent anastomosis in order to avoid acute, possibility lethal diaphragmatic infarction. With careful isolation of the bifurcation and its primary branches, the majority of even heavily calcified vessels can be grafted without endarterectomy. If a totally obstructed and poor quality right coronary artery is well filled by collaterals from the left, it may not be necessary to bypass the right coronary artery when successful grafting of the left anterior descending or circumflex branches or both has been accomplished. Although the right coronary artery is frequently more diffusely diseased than the left coronary branches, with careful selection of the anastomotic site and attention to surgical detail, the vast majority of these arteries can be successfully bypassed.
D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000033:anatomy & histology; D004691:Endarterectomy; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*