[HSF] anomolous RCA

[Tea Acuff]

Sudden death has been reported with CAB, but not reported very often. I do, however, have personal experience with it.
tea


----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, February 6, 2007 5:52:50 AM
Subject: Re: [HSF] anomolous RCA


Sudden death has been reported even for the RCA.
Prasanna
Ramaiah, Chandrashekar wrote:
> Prasanna,
> Sudden death has been reported and I have taken care in case of Left Coronary. I do not know if you can say the same for RCA.
> Hal: You can even do RIMA to RCA with robotic harvesting and without sternotomy but I still say nothing needs to be done in this case.
> Chand
>  
>
> Chand Ramaiah, MD
> Director,Heart Transplantation
> Director, Minimally Invasive Cardiac Surgery
> University of Kentucky
>
> -----Original Message-----
> From: "prasannasimha" <prasannasimha at gmail.com>
> To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>
> Sent: 2/5/07 8:42 PM
> Subject: Re: [HSF] anomolous RCA
>
> An anomalous coronary vessel coursing between the aorta and RCA is known 
> to cause sudden death during exertion. This is because of PA dilatation 
> and compression during exercise and is well described in literature.
> This is an indication for a CABG. Usually a vein graft or a RIMA can be 
> placed. If placing a RIMA graft it may string but I have seen them open 
> up when proximal CAD has occurred. Incidentally that is what happened to 
> Acar's radials over years which actually revived interest in radials.
> Prasanna
>
> Hgrmd at aol.com wrote:
>   
>> 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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