title: Anomalous right coronary artery from the left sinus: a minimally invasive approach.
abstract: OBJECTIVE
  Anomalous right coronary artery arising from the left sinus (ARCA) is a known cause of sudden cardiac death, particularly in young athletes. Surgery is recommended for all adult patients who are symptomatic or who have evidence of exercise-induced myocardial ischemia. Surgical options include coronary artery bypass grafting (CABG) and anatomic correction by unroofing the ostium or by reimplanting the ostium into the right sinus of Valsalva. We describe the rationale and technique of a minimally invasive right thoracotomy approach for correction of ARCA.
  
  
  METHODS
  We reviewed all patients with coronary artery disease operated upon at Mount Sinai Medical Center. Between March 2008 and September 2010, 17 patients underwent surgery for anomalous coronary origin from the opposite sinus of Valsalva. Nine of these patients had ARCA. We describe four adult patients with ARCA who were operated upon using a small right anterior thoracotomy incision to perform a right internal mammary artery (RIMA) to right coronary artery (RCA) bypass with ligation of the proximal RCA. This was performed under direct vision and without cardiopulmonary bypass.
  
  
  RESULTS
  There were two male and two female patients. Mean age was 55.3 ± 4.8 years (range 50-61 years). Three of the patients manifested chest pain and one each syncope, dyspnea, and palpitations. Two patients had preoperative stress testing that was positive for ischemia. Postoperative follow-up (mean 14 months and range 5-37 months) is complete. All patients are alive and asymptomatic.
  
  
  CONCLUSIONS
  ARCA can be managed with good early and midterm results using a minimally invasive right thoracotomy approach.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY 10029, USA. ramachandra.reddy@mountsinai.org
authors.forename: Ramachandra C
authors.initials: RC
authors.lastname: Reddy
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Takahashi
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Beckles
authors.forename: Farzan
authors.initials: F
authors.lastname: Filsoufi
mesh_terms: D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D057234:Preoperative Period; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome