[HSF] anomolous RCA

[Tea Acuff]

With that anatomy, what you propose should work. If you did a primary transposition, you would do it anteriorly anyway. Your radiologist does not know anything about coronary disease. His risk of dying from a small RCA is approximately the risk of the operation. It should fix his symptoms, however.
tea


----- Original Message ----
From: "Hgrmd at aol.com" <Hgrmd at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, February 5, 2007 6:12:19 PM
Subject: Re: [HSF] anomolous RCA


Chand,
  I wish I could show you the 64 slice CT scan.  It clearly shows  an RCA 
arising from the left coronary sinus.  It appears to be a string  during its 
course between the left side of the ascending aorta and the right  side of the 
MPA.  Distally, it appears normal caliber and terminates in a  nice PDA.  I don't 
see much of a posterolateral branch, and suspect it is a  codominant system.  
The LM, LAD, and Cx appear unremarkable. The  radiologist interprets the scan 
as an anomolous RCA with a "potentially lethal"  anatomy.  I've referred the 
case to a cardiologist I trust and will get his  opinion regarding the need 
for a cath.  Quite honestly, though I don't have  much experience in 
interpreting 64 slice scans, this appears to be an excellent  study.  The patient has had 
exertional angina that began about a month  ago.  Interestingly, a nuclear 
scan reveals mild anterior  reversibility.  
  My initial plan is to place a RIMA to the RCA and probably close the  RCA 
at its course between the aorta and the PA.  Looks to me that  mobilizing the 
RCA off the left sinus would be a dangerous royal pain. Any other  suggestions?
Hal
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