Diagnosis and operation for anomalous circumflex coronary artery.
BACKGROUND
Origin of the left circumflex coronary artery from the right sinus of Valsalva is the most common anatomic variation of the coronary artery circulation. However, there are few reports about the operative approach to this anomalous vessel.


METHODS
Forty patients having this anomaly were identified from 10,216 adult cardiac catheterization procedures. Forty percent of the anomalous circumflex coronary arteries (ACCAs) had critical atherosclerotic lesions. Eighty cases needed bypass grafting.


RESULTS
For diagnosis of ACCA, the aortic root sign was positive in 94.9% of the diagnosed patients and the nonperfused myocardium sign was found in 92.5%. Eighty percent of ACCAs were larger than 2 mm in radiographic diameter before their passage into the atrioventricular groove. However, after emerging from the atrioventricular groove, 70% measured less than 1.5 mm. Consequently, a technique was developed to bypass the proximal ACCA and was used in 2 cases. Six other patients with more distal disease and larger vessels underwent conventional bypass grafting.


CONCLUSIONS
The aortic root sign and nonperfused myocardium are useful in diagnosing ACCA. The ACCA is usually too small for use of the conventional graft technique. Therefore, a technique was developed to graft more proximally and was applied successfully in 2 cases.
Ueyama
K
K
Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Ramchandani
M
M
Beall
A C
AC
Jones
J W
JW
D000328:Adult; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans